healthcare consumerism solutions jan/feb '13

PRSRT STDU.S. Postage

PAIDPermit #104

Ft. Atkinson, WI

The Value of Private Exchanges

Defi ned Contribution Model, Private Exchanges Shifting

Power to Consumers

How Health Care Reform Will Impact Vision Benefi ts – Bringing the Facts Into Focus

FORUM East · May 9-10, AtlantaFormerly CDHC Solutions

ISSUE || January/February 2013

Transforming How Insurance is Purchased,

Received

EXCHANGES

www.theihcc.com

Reduced his health

claims. Saved the

company $700.

Healthcare is

Predictable

Implemented

Healthstat for his

company last year.

Found out he had

diabetes. Learned

to manage it at work.

Reduced his health

claims. Saved the

Implemented

Healthstat for his

company last year.

010463_5_Healthstat_cdhcsolutions_newlogo.indd 1 2/13/12 6:03 PM

www.TheIHCC.com I HealthCare Consumerism Solutions™ I January/February 2013 3

I N S I D EFEATURES

28-36 EXCHANGES Transforming How Insurance is Purchased, ReceivedThe 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.

40 How Health Care Reform Will Impact Vision Benefits – Bringing the Facts Into FocusWhat’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

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

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.

David Urbaniak

35 Public Exchanges Must Answer Multiple Questions Under Tight Deadlines

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

Reduced his health

claims. Saved the

company $700.

Healthcare is

Predictable

Implemented

Healthstat for his

company last year.

Found out he had

diabetes. Learned

to manage it at work.

Reduced his health

claims. Saved the

Implemented

Healthstat for his

company last year.

010463_5_Healthstat_cdhcsolutions_newlogo.indd 1 2/13/12 6:03 PM

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.

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

6-7 What’s Happening at The Institute

8 Editor and Publisher’s LetterHealthCare Consumerism Solutions Expanding to Include Exchange Solutions

11 Guest CommentaryFifty-two Card Pickup

Greg Scandlen

13-17 IHC FORUM East PreviewMaking Consumerism WorkSpeakers and FORUM agendaBenefits for attending FORUMSuper Saver and Early Bird Rates

18-20 People on the Move

18-20 Briefs/InnovationsAetna Consumer-directed Health Plans Continue to Save

Millions for EmployersTruven Health Analytics Develops Solution to Evaluate Wellness

Program EffectivenessUnited Airlines Opens Free Workplace Health Clinic at O’HareMercer Selects Benefitfocus to Provide Technology Platform for

Private Exchange

43 Who’s Who Profile

50 Resource Guide/Ad Index

21 Regulatory & ComplianceDevelopment of Private Health Insurance Exchanges Predate PPACA

Ron Bachman

23 HSAsEvolutionary Health Care Financing: The Global Switch to HSAs

J. Kevin A. McKechnie

24 Population Health ManagementCorporate Wellness: 2013 is Time for an Upgrade

Dr. Dee Edington

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

Randy Finn

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

Sumit Dutta

27 Health Care Access AlternativeConsider an On-site Wellness/Telemedicine Team for Better Employee Engagement

Tony Chandler

I N S I D E DEPARTMENTS

Events

The 2013 IHC FORUM Eastwww.theihccforum.comFor 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 pre-conference, 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.

Become a Member and Reap the RewardsHave 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.

WHAT’S HAPPENING AT THE INSTITUTE?members speak out


spotlight

John Young, 2012 John J.

Robbins Senior Memorial

HealthCare Consumerism

Leadership Award winner

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.

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.

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

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

as a speaker and moderator at The Institute for HealthCare Consumerism’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.

.

THE CEO’S DESK 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


WHAT’S HAPPENING AT THE INSTITUTE?online exclusives

events

Costco Offers Pharmacy Benefi t Management Services Costco Wholesale, the business known for its low prices and oversized products, has entered in

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.

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 nation’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 market’s approach to health reform. While health care costs have sky-rocketed in

to keep costs down, Mackey has personally taken the role of curbing health costs and improving employees’ 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 Consumerism’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 “Health Care Reform,” wherein he

Transparency + Accountability

I celebrate the efforts of the state of Massachusetts to advance price transparency within health care. With the

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

providing their workers the ability to compare prices.

DISCUSSIONS Three Tips to Integrate Physical and Financial Wellness

Your wellness campaign may be missing a huge

Employers use it in their communication as their go-to term for physical health. There’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

or retirement and having enough money to enjoy the weekends with the kids. Your campaign should address

as equal to physical health. That means encouraging

offer.

Why I Am More Egalitarian Than Most Liberals on Health Care

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

of Canada’s system of socialized medicine. I’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 — even as they oppose ObamaCare.

Follow us on Twitter:Twitter.com/The_IHC

Join the discussion in LinkedIn Group: HealthCare Consumerism FORUM by IHC

Join our Facebook Group:The Institute for HealthCare Consumerism

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2013Register Now and SaveDon’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.May 9-10 Cobb Galleria Centre Atlantawww.theihccforum.com

LEARN. CONNECT. SHARE.

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 employers—and the multi-stakeholders working with them —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 “HealthCare Exchange Solutions,” 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 “HealthCare Exchange Solutions.” 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 IHCContinuing to utilize our multi-media platform at The Institute, HealthCare Consumerism Radio

is back and new and improved. With our new radio partner, America’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 members’ convenience.

Register for Forum and SaveAfter visiting The IHC website, browse the Exchange Solutions community and read the

“HealthCare Consumerism Exchange Solutions,” 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.

Todd CallahanEditorial [email protected]

Doug FieldCEO/[email protected]

L E T T E R EDITOR & PUBLISHERwww.theihcc.com

VOLUME 9 NO. 1 | JANUARY/FEBRUARY 2013

Published by FieldMedia LLC292 South Main Street, Suite 400

Fax: 770.663.4409

CEO/ PUBLISHER/EDITOR-IN-CHIEFDoug Field

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Brent Macy

EDITORIAL DIRECTORTodd Callahan

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Joni Lipson

Rogers Beasley

ART DIRECTORKellie Frissell

CHAIRMAN OF IHC ADVISORY BOARDRonald E. Bachman, CEO, Healthcare Visions

EDITORIAL ADVISORY BOARD

Kim Adler, Allstate;; Diana Andersen, Zions Bancorporation;; Bill Bennett;; Doug Bulleit, DCS Health;; Jon Comola, Wye River

HSA Rewards;; Roy Ramthun, HSA Consulting Services LLC;;

WEBMASTER Kevin Carnegie

Tom Becher

REPRINTSRogers Beasley

Karen Raudabaugh

™ Volume 9 Issue 1Copyright ©2013 by FieldMedia LLC. All rights reserved.

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© 2013 Total System Services, Inc.® All rights reserved worldwide.

TSYS® is a federally registered service mark of Total System Services, Inc.

A winning combinationOur unique experience in both the healthcare and payment services industries means unmatched expertise and reliability. Known for our elite levels of customer service and a long-term commitment to the industry, TSYS Healthcare® is focused on lasting relationships and people-centered paymentsSM.

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Get to know us. [email protected]


Remember when you were a kid and someone asked you if you wanted to play “fifty-two pickup” 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 “health reforms” as envisioned by Washington, but about what is happening in the market. The “reforms” 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 Boyles’ latest issue of “Consumer Driven Market Report.” (For subscription information, e-mail Bill Boyles at Interpro Publications [email protected])

Things had been quite stable for half a century before Consumer-driven 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 “allied professionals,” labs and drug stores. And that was the “system.”

All this began to change with the advent of cash accounts in health care financing—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 “new configuration” is “ACCOUNTS-CARDS-INCENTIVES,” all powered by technology. Notice that he gives insurers barely a mention.

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 “Lookouts” (not “outlooks”) 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

as they can no longer ask medical questions of applicants. He concludes—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 is—Everybody will be looking for relief from the incredible complexity of the ‘new’ 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 doesn’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 everyone’s market position.

I haven’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.

2006.

in 2007.

We can’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.

Fifty-two Card Pickup

BY GREG SCANDLENFOUNDER

CONSUMERS FOR HEALTH CARE CHOICES

GUEST COMMENTATOR

©2013 Truven Health Analytics Inc. All rights reserved.

Start Planning Now for a Successful 2014 Enrollment Period While this year’s open enrollment challenges are still top-of-mind, now is the time to ensure that your next open enrollment process will be ideal — for your employees and your organization.

The Right Plan for Your EmployeesIncreases in plan complexity, costs, and accountability can make employees lose sleep over whether they’re choosing the right plan for their situation. Truven Health Informed Enrollment provides personalized, actionable information to quickly guide them to their best-fit plan.

The Right Plan for YouHelping employees select the best plan benefits your organization, too. With Informed Enrollment, our clients have seen outstanding results, such as: 60-percent decline in the number of over-insured employees 20-percent increase in consumer-driven health plan enrollment 30 percent of all employees moved to a new plan that better met their needs

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– Actual Employee Email to Human Resources Regarding Informed Enrollment

2013

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

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

FEATURED SPEAKERS:

WHO SHOULD ATTEND?CEOs/Presidents/CFOs

Health Plan AdministratorsCorporate Wellness and Medical Directors

Third Party Administrators

MAKING HEALTHCARE CONSUMERISM WORKIn the Year Ahead and Beyond

WWW.THEIHCCFORUM.COM

Wendy LynchCo-director, Altarum Center for Consumer Choice in Health Care

Chris CovillExchange Product Leader and PartnerMercer

Dawn BadingVice President, Human ResourcesKaiser Permanente

Cindy GillespieSenior Managing DirectorMcKenna Long & Aldridge LLP

Patti Taylor

Newell Rubbermaid

Steve Lafferty, Sr.Director of Clinics and Health Partnerships, Target

John HickmanPartnerAlston+Bird LLP

ATLANTA MAY 9-10, 2013

2013 WWW.THEIHCCFORUM.COM

IF YOU CAN’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.COMLAS VEGAS DEC 5-6, 2013

NO OTHER CONFERENCE IS DOING WHAT THE IHC FORUM DOES!

WHAT YOU’LL LEARN

NEW AT THE FORUMOur Employee Benefits Forum Pre-Conference (produced in conjunction with WEB Atlanta) is exclusively designed for employers. This is your chance to talk shop—uncensored—with your professional counterparts.

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

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:

Experts

participation

is engaging, educational and packed with networking and new business

along the road.

brokers and regional health plan providers interested in engaging their

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

health and benefit offering

health care law

Doug FieldFounder and CEOThe Institute for HealthCare Consumerism

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 – 5:15 pm Pre-Conference: Employee Benefits Forum 2013

1:00 pm – 5:00 pm Pre-Conference: A Roadmap for Making Healthcare Consumerism Work

12:00 pm – 7:00 pm Exhibitor Set Up

THURSDAY, MAY 9, 2013

7:30 am Registration

7:30 am – 8:45 am Networking Breakfast / Exhibits Open

8:45 am – 9:00 am Welcome by Doug Field, CEO, The Institute for HealthCare Consumerism

9:00 am – 10:30 am Opening General Session: “Making Health Care Consumerism Work”

10:30 am – 11:00 am Networking Break / Exhibits Open

11:00 am – Noon Track No. 1 Workshops (Choose One)

102 – HSAs: After 2014

a Partnership

105 – Health Pays: Using Incentives to Drive Wellness and Behavior Change

106 – The Right Care (Not Just Cost)!

107 – Pre-Paid Card Programs to Engage Consumers and Help Employers Manage Costs in 2014 & Beyond

Noon – 1:00 pm Table Topic Lunch Discussion

Noon – 1:30 pm Lunch / Exhibit Open

1:30 pm – 2:45 pm Afternoon General Session: “HealthCare Consumerism is Here to Stay!”

2:45 pm – 3:00 pm Networking Break / Exhibits Open

3:00 pm – 4:00 pm Track No. 2 Workshops (Choose One)

202 – Ownership and Incentives: Creating Multiple Incentive Channels

204 – SHARE SESSION: Health Care Access When You Want It, How You Want It

205 – The MedEncentive Solution: Achieving the Triple Aim by Triangulating the Interests of Payors, Providers and Patients

206 – SHARE SESSION: How to More Effectively Engage Consumers and get Increased Participation from your Employee Population

207 – Consumer Engagement: The Key to a Successful Exchange

208 – Ten Steps to Delivering on the Promise to Employers: ACOs Enhance Quality of Care, Improve Patient

4:00 pm – 4:15 pm Networking Break / Exhibits Open

4:15 pm – 5:15 pm Closing General Session: Defined Contribution and Public/Private Exchanges: A Panel Discussion with Leading Experts

5:15 pm – 7:15 pm Opening Night Reception / Exhibits Open

Professional Credits Available for CRCs and HR ProfessionalsThe 2013 FORUM East Program

Hotel InformationRenaissance Waverly Hotel

800.228.9290 or 770.953.4500

Special FORUM Rate $153 (Cutoff Date 4/17/13)

Conference LocationCobb Galleria Center

Atlanta, GA 30339

PHR

®

SPHR® GPHR

®

HR Certification Institute

®

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.

2013 FORUM EAST AGENDA CONTINUEDFRIDAY, MAY 10, 2013

7:30 am – 8:30 am Networking Breakfast / Exhibits Open

8:30 am – 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 – 10:30 am Networking Break / Exhibits Open

10:30 am – 11:30 am Track No. 3 Workshops (Choose One)

302 – The Economics of Healthy Sleep

304 – Improving Consumer Health Through Value-Based Plan Design

306 – The Role of Mobile Health in Changing Behavior

308 – SHARE SESSION: Building Better Consumers of Health Care and Health

11:30 am – Noon Final Break and Sponsor/Exhibitor Drawings

Noon – 1:00 pm Closing General Session: Employer Panel: “What leading Employers are doing to Make HealthCare Consumerism Work

For the latest updates, program details, speaker bios and to register, visit www.theihccforum.com or call 404.671.9551

REGISTRATION RATES FOR FORUM EAST - MAY 9-10, 2013

Member / Non-Member Early Bird Rates Standard Rates Onsite Rates Attendee Type (ends 2/28/13) (ends 4/30/13) (ends 5/09/13)

Please Note: Rates above do not include member discount.

Gold Sponsors

Silver Sponsors

Exhibitors

Produced by

Partnered with

Attendee Pricing Includes: Group Rate Discount Available

Receive a 25% discount on each person when you sign up two or more

IF YOU CAN’T MAKE EAST, START PLANNING NOW FOR IHC FORUM WEST!DEC 5-6, 2013, THE RED ROCK RESORT IN LAS VEGAS

DETAILS AVAILABLE SOON AT WWW.THEIHCCFORUM.COM.

www.theihcc.com


PEOPLE ON THE MOVEBRIEFS

Aetna Consumer-directed Health Plans Continue to Save Millions for Employers

The ninth annual Aetna HealthFund study shows that employers

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 doctor’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

HealthFund members also had higher rates of screenings for cervical

“Employers are trying to control rising health care costs by getting their employees to be more empowered when making health care decisions,” says Tom Mafale, head of national accounts sales operations for Aetna. “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.”

Employers that completely transitioned their employees to Aetna HealthFund plans saw the most dramatic cost savings. However,

study had cost savings that were almost as high as the employers who completely switched over to HealthFund plans.

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,

of population health and wellness programs. The Truven Health ROI

Model is designed to help organizations identify which health risks are most prevalent and costly to their company, quantify the relationships

on the results.

demographic, health risk, and program impact data, plus data from peer-reviewed studies. It shows the relationship between health risk and cost,

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

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,

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.

United Airlines Opens Free Workplace Health Clinic at O’Hare

United Airlines announced the opening of the airline’s new employee health clinic at O’Hare International Airport. The clinic, managed by Walgreens, will serve a broad scope of employees’ health needs, such as urgent care for routine illness, travel and other immunizations including

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.

investments in our co-workers,” said United’s Chairman, President and CEO Jeff Smisek. “This clinic will offer convenient health services at no charge to keep our co-workers feeling and performing well.”

The 5,200-square-foot facility, located in the airport’s Terminal 2 arrivals area, is the only one of its kind for any airline at O’Hare. United

PEOPLE ON THE MOVEMedConnections, one of the world’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. MedConnections’s flagship application, iPharmacy, has already helped more

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 (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 company’s most

A E T N A » T R U V E N H E A L T H A N A L Y T I C S » U N I T E D A I R L I N E S » M E R C E R » B E N E F I T F O C U S » T E X A S H E A L T H R E S O U R C E S » H E A L T H W A Y S

Niziak

HEALTHCARE CONSUMERISM SOLUTIONS


also offers health care clinics for its employees at its Cleveland, Houston,

centers and wellness programs to improve the overall health, satisfaction and productivity of their employees, while also reducing costs,” says

two companies with deep Chicago roots to make health and wellness a top priority.”

by Walgreens. United’s O’Hare facility adds to the more than 370 employer-based worksite health and wellness centers managed and

Mercer Selects Benefitfocus to Provide Technology Platform for Private Exchange

technology, announced it will provide the technology platform for the

leader in talent, health, retirement and investments. Mercer Marketplace is a cloud-based private exchange designed to lower employer costs

exchange, will provide Mercer’s clients the convenience of an online retail marketplace where they can shop, enroll, manage and exchange all

“Mercer Marketplace is an important addition to the suite of solutions that Mercer provides to clients,” says Sharon Cunninghis,

which is an important attraction and retention tool, while actively managing spending and reducing their administrative responsibilities.

support to make appropriate decisions.”

of an employee’s income or a standard amount set by the employer, further

Texas Health Resources, Healthways Advance Physician-directed 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.

approach to optimize the care of inpatients with diabetes and improve coor-dination of care after the patient is discharged. Texas Health launched the

-pitals in Dallas, Plano, Arlington, Hurst-Euless-Bedford and Fort Worth.

readmissions, and aligns inpatient and post-hospital care teams around the patient’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 Health’s overall strategy to integrate health services and help patients navigate through the complex environment of care.

Both approaches involve the patient’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.

“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,” Doug Hawthorne, CEO of Texas Health Resources, says. “Beginning with the physicians, nurse practitioners and physician assistants of Texas

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.”

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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 Aflac’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 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 Empire’s local group and individual business in New York, including sales, account management, provider relations and contracting, Magnacca



underwriting and product delivery, as well as maintaining customer relationships. In addition, he will be responsible for the development of Empire’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 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 Caterpillar’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 Aetna’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 Aetna’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

Treatment Selection & Shared Decision Support Platform

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heart health

muscle, bone, and joint issues

pregnancydiabetes

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Taylor


Who: Individuals, small employers and large groups. Private exchanges target:

Employers who want to better control their health care costs,

for their own families,The need for portability as workers move between jobs, andThe need for two-income families to combine their resources into a

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

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

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

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

same insurer.

Independent companies: Developed with various sponsorships, existing relationships, and business models. These companies include existing

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.

able to contribute only what it can afford.Employees will be able to choose their plan design, the one that works best for their own family.

Coverage will eventually be portable, so employees can keep the same coverage as they change jobs, or lose their job altogether.

Unlike individual coverage today, the employee contribution may be tax free through using a Section 125 payroll deduction.

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

effective uses of private exchanges.

empowerment” a reality. People want to have more control over their own lives. They are demanding choice and individual ownership of their health

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

will need to determine the economics and employee attitudes in moving to a

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.

!e information presented and contained within this article was submi"ed by Ronald E. Bachman, President & CEO of Healthcare Visions and the Chairman of the IHC Editorial Advisory Board. !is 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.

Development of Private Health Insurance Exchanges Predate PPACA

REGULATORY & COMPLIANCEBY RONALD E. BACHMAN FSA, MAAA

CHAIRMAN EDITORIAL ADVISORY BOARDTHE INSTITUTE FOR HEALTHCARE CONSUMERISM


Winter in Edmonton, Alberta isn’t for the weak at heart. We arrived in the fall of 2006 after a quick layover in already chilly Chicago.

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 doubling—at least in Red Deer—every 18 months?

The call on Alberta’s treasury was enormous, as was the inability of what remains a systemic issue in the province’s health care delivery

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

provinces or even out of Canada to the United States for care. Once the other Canadian provinces realized they were treating Alberta’s workforce without gaining Alberta’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, doesn’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.

Sound Familiar?

system even more attractive to American government than the oil boom makes it to Alberta. As the uninsured gain access to subsidized health care

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 Alberta’s oil-workers have—cash.

Why is that Going to be Such an Advantage?The ACA marches the reach of America’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 can’t have an HSA—at least not yet;; but give me and my team a year and we’ll see—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.

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.

Who Will Win?The government is hedging its bets. Before the Christmas holidays,

two major changes in administration regulatory posture gave this industry

calculator making it nearly impossible to disqualify an HSA-plan from sale in an exchange.

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.

Consumer Information & Insurance Oversight, who appeared before the House of Representatives on Dec. 13, 2012.

“The [MLR Rule] 80/20 rule says insurance companies have to spend 80 cents of every premium dollar on care,” says Cohen about the

dollars are actually expended, they will be counted toward that 80 cents that the insurance company has to spend.”

What Does this all Mean?It means that the administration has taken the positive steps the

HSA Council asked them to make to ensure the most affordable plans—

companies won’t be penalized in their MLR performance for continuing to

plans will not only have a way to save for future care but also will have a

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.

Evolutionary Health Care Financing: The Global Switch to HSAs

BY J. KEVIN A. McKETCHNIEEXECUTIVE DIRECTOR

AMERICAN BANKERS ASSOCIATION’S HSA COUNCILHSAs


Dmeets with each employee and their spouse

their options. He has a nearly 100 percent client retention rate and close to 100 percent employer satisfaction rates.

and employees may not seem like a wellness strategy, but it is one—if not the best—investment in engaging

their health. Elliott’s approach is an important step in the right direction as we strive to help our corporate clients establish a culture of health within their organizations.

Corporate wellness initiatives have been around for 40 years, beginning in the early 1970s. The early wellness programs and those leading up to 2013 concentrated on tactical individual behavioral change. After four decades of programming, it is clear the results have been disappointing and, in fact, are stuck at a less-than-optimal position within nearly every organization. There is little to no evidence our population is healthier or more productive today than when the programs began.

However, what has emerged is a growing awareness of the potential of a healthy workforce. Corporate and political leaders have never been so interested in how good health can impact costs and productivity, making now an opportune time to bring wellness programs to a higher level of engagement. Realizing this opportunity is the responsibility of

to organizations.

New and Progressive Strategies for 2012 Developing low-risk maintenance strategies illustrates the type of

widespread, culture-based thinking that is critical as companies move toward the successful implementation of new, inspired approaches to helping individuals and the workplace thrive in a sustainable way. That opens the door to Elliott’s approach to engaging employees in their health

less expensive programs. An idea that will gain traction over the next few years is focusing on the

web-based applications assess an individual’s health risks and behaviors, calculate the excess costs of any risks and demonstrate potential savings.

informs individuals of potential debilitating chronic disease that could rob them of their health and retirement security.”

created and implemented by Chris Hogan and Scott

Their “Trend Neutralizer” system was developed to show the 50-250 employee companies the role cost trend plays in the calculation of future costs. The need for this system arose from the inability of the carriers to provide the utilization cost data. The Trend Neutralizer provides the underwriter with the opportunity to retrospectively evaluate a client’s performance in seven areas that all parties agree leads to better outcomes. If the client performs consistent with best practice, their trend factor may be reduced to zero. The carrier has none of the risks of a prospectively based pricing strategy;; however,

the carrier is able to reward the groups who are doing what the carrier wants them to do without having to subsidize the expenses for groups that are not in compliance.

Emeryville, Calif., in considering the impact of PPACA to small businesses, came to the conclusion the employer will never be absolved of the responsibility to have a healthy workforce whether the employees get their insurance from the exchanges or through the employer. Regardless the

drive down costs and improve workplace effectiveness because the employer will have very little control to affect premium outcome in the exchanges. Purchasing insurance in the traditional sense will likely result in lower costs when the employer becomes engaged in promotion a culture of health.

working with clients says David Rearick and Stephen Cherniak at Marsh & McLennan Agency LLC in Atlanta.

We achieve that by assisting our clients with a focus on vision and environment. A vision from leadership that supports the principle that “good health is expected—not hoped for”;; and an environment that focuses on and is supportive of the workforce’s ability to do their job and manage their lifestyle.

Finally, today it isn’t about wellness—it is about well-being. We need the objective data like biometrics;; but a high blood pressure or BMI is often the result of an unhappy marriage, someone with an abuse problem,

resource challenges that every health enhancement strategy must look for and address.”

Corporate Wellness: 2013 is Time for an Upgrade

BY DR. DEE W. EDINGTONFOUNDEREDINGTON ASSOCIATES

POPULATION HEALTH MANAGEMENT


Tincluding high-deductible health plans and health savings accounts, are gaining traction. These options can help employers drive down the cost of

even more advantages for employers and employees.

High-deductible Plans are Growing in PopularityStatistics 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

offered in conjunction with HSAs, tax-preferred accounts employees can use

How large is the average deductible for employees in today’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 coverage—a number that has tripled since 2006.

Increasing the deductible on a company health plan can help employers

and communicated properly, such a move can be highly unpopular with the employee population.

Voluntary Products Can Pair Nicely With HDHPsTo 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

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.

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.

Voluntary

medical out-of-pocket expenses related to a hospital stay.Cancer and critical illness insurance: Employees diagnosed with cancer or another covered critical illness, such as a stroke

insurance deductibles and copayments as well as nonmedical expenses.

Accident insurance:

insured is injured as a result of a covered accident — injuries such as joint dislocations, broken bones, burns, lacerations

for nonmedical and medical out-of-pocket expenses such as deductibles and copayments resulting from a covered accident.

Don’t Overlook the Importance of Benefits CommunicationWhen 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. That’s why offering clear and

Choosing a voluntary carrier offering complimentary one-to-one counseling as part of its enrollment services help employees understand

removes a major hassle for the employer.

counselors during their enrollments prove the effectiveness of the one-

needs.

The Role of Employers is Changing

employers. No longer are they always providing and paying for traditional

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

BY RANDY FINNASSISTANT VICE PRESIDENT, PRODUCT DEVELOPMENT

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY

SUPPLEMENTAL HEALTH MANAGEMENT


Tunderstand. This is especially true during periods of transition, like now, when the health care industry is adapting to dramatic changes.

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.

Health Care ReformThere are more than 48 million uninsured

Americans today. Although many of the uninsured are working, some employers may not offer health insurance or employees may not be eligible. We know the uninsured are more likely to forego health care services when they are ill, but starting in 2014, nearly all Americans will be required to obtain health care insurance. For the working uninsured, if their employer does not offer a plan, employees will be able to purchase insurance through a health care exchange.

are structured, but not just for the previously uninsured. Catamaran’s response is to focus

drug distribution channel such as retail, independent, chain or mail service pharmacies.

Specialty TrendFor many payers, specialty drug trend exceeded 20 percent in

2012, and this included drugs where the average annual costs are tens of thousands of dollars. In fact, specialty drugs can even reach hundreds of thousands of dollars annually on the extreme end of the cost spectrum. Large PBMs have dedicated specialty pharmacy divisions, like Catamaran’s BriovaRx Specialty Pharmacy, to help payers, providers and patients, with the complexities involved in managing these expensive medications.

The strategies employed by specialty pharmacies to manage rising drug trends include narrowing the specialty pharmacy distribution network, prior authorization and step therapy, determining appropriate plan design, preferred products in certain specialty classes and high

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

Outcomes FocusThe 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 began adjusting downward reimbursement rates for hospitalizations for three conditions: heart attack, heart failure and pneumonia. Managed care organizations are experimenting with new contracting models with accountable care organizations to reimburse based on new outcome measures. Catamaran is partnering with its clients to provide pharmacy information and reporting to their members’ physicians to support these new contracts.

As we move forward in this evolution of health care, Catamaran is continuously focused on bringing more value to the clients we serve. Recent investments include mobile technologies that provide smart phone users with myriad capabilities such as medication adherence reminders, drug interaction alerts and information on cost-effective medications.

We also utilize patient risk scoring models in order to better allocate our clients’ health care dollar on patient engagement that is more likely to bring near-time value. Catamaran offers

to closely monitor industry dynamics, our focus remains on building a

Pharmacy Benefit Management Business Adapting to Demand for Specialty Medications

BY SUMIT DUTTOSENIOR VICE PRESIDENT AND OFFICERCATAMARAN

PHARMACY BENEFIT MANAGEMENT


Wellness programs are here to stay. There are many different types and paths to follow, each company needs to strongly look at what they need for a wellness plan. What results are they after?

Telemedicine also is an up-and-coming strategy used by many successful companies to improve employee satisfaction both at home and work. A major question is how you get employees to actively engage in both wellness and telemedicine for productive results. One of the most successful approaches is actually having a wellness/telemedicine team established on-site at the employer group.

It is important to choose individuals who have power or the respect of the employees. Respect is the key factor. In this way it is easier to engage all the other employees. By having a team of employees put together to coordinate activities, it becomes a more managed process.

Setting up schedules for the months ahead also served to increase engagement. Posters in the lunch rooms or common meeting places of the employees should be placed as

this correspondence is put together to get the word out, but it must be communicated by the wellness/telemedicine teams to the employees. Some groups have actually implemented a cost approach whereas the employee would pay more if they don’t comply to a wellness plan, such as quitting smoking or entering into a weight cessation program. This may be seen as

regard to results.Here are some of the most effective methods seen to engage

employees in wellness plans. One large automotive dealership, with multiple locations, started a few years ago by installing on-site gymnasiums for employee use. Not a full-blown gymnasium, but a treadmill, exercise bike lightweights and basic weight training. The treadmill is even equipped with a platform for a laptop computer to

Another incentive is cash rewards for proof an employee has had his or her annual physical and all testing associated with the exam. This is not meant to be invasive or intrude on someone’s privacy, but it is used as a method to prove the employee has complied.

Staying with the cash theme, we have seen a remarkable employer incentive where they offered $50 for every pound lost and kept off during a contest time frame. One employee received a check for almost $1600! Now that’s taking wellness seriously! The above incentive also works well where the employee receives a gift card for completing a health risk assessment.

Based on the common promotion of health reimbursement accounts within group

checklists where employees get points for completing items. The more points they get the greater reimbursement they receive from their HRA. It’s a positive program, and the employees always know where they stand with their HRA bank.

Telemedicine has and will continue to reduce health care claims. Therefore employers use incentives here as well to increase engagement. Once it is communicated properly in a group setting and through written communication, employees will

understand this method. No longer will they need to leave work in the middle of the day to take a sick child to the doctor. When used properly, most employers will reimburse a portion of the expense to utilize this technology as an incentive to increase usage. We have seen rewards given to employees at the end of the year when they can see the reduction in emergency room visits.

As you can see, money talks and will continue to do so as the primary incentive to engage employees in these phenomenal programs.

reducing stress, will go a long way toward bending the health cost curve and reducing health care expenses.

Consider an On-siteWellness/Telemedicine Team

for Better Employee Engagement

HEALTH CARE ACCESS ALTERNATIVE

BY TONY CHANDLERPARTNER

HEALTH SOLUTIONS INSURANCE AGENCY


THE VALUE OFPRIVATE 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

burdening taxpayers.The value of an exchange, public or private, goes well beyond the

better manage their portion of health care costs. Exchanges, or perhaps a

BY ERNIE HARRIS » CHIEF STRATEGY OFFICERWORKABLE SOLUTIONS

THE VALUE OFPRIVATE EXCHANGES



Costs are on the riseControlling 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

Employer Benefi ts

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.

of an electronic system but cannot afford the high costs of the solutions

available today for large employers for a fraction of the cost. According to the U.S. Census Bureau’s 2010 report, there are more

than 5.734 million employers in the U.S.—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

maintenance and billing saves an average of $165 per employee per year.

Show Me the MoneyEmployers can save 13 percent or more by moving to a private

and management experience. For the average company employing 100 people, that’s a savings of almost $2,000 per year in administrative

improvement over the traditional paper enrollment process.

Convenience

most small employers remitting payment to multiple providers monthly

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 employer’s leadership team.

Employee Benefi tsIndividuals continue to feel the costs associated with increased

insurance premiums every year. According to the Kaiser Family Foundation

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

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:

Insurance is not a vehicle to manage the day-to-day expenditures

insurance has evolved into over the past 50 years—a payment plan more

simple;; be an active consumer of health care.Consumerism is the fundamental force that aligns commercial

how much health care actually costs—it’s funny money because under the

is that we need health insurance and it should cover whatever we need.

Insurers are not necessarily greedy but they are businesses that must

A 2011 survey of hospital emergency room costs reported the cost

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

beyond that paid for by the insurance company and seen as “free” by the consumer. A great plan for the consumer, but not necessarily a long-term

Online Benefi ts Marketplace ValuesEmployer Benefi ts

Employee Benefi ts

Carrier Benefi ts

General Insurance

Health Insurance


What are the Alternatives?

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 “routine” visit—nearly half of the lowest reported cost to visit

Managing Out-of-pocket Costs

can’t afford to bear the cost of health care needs as budgets are tight in a down economy;; 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

high-deductible plans, they also can participate in a health savings account

would allow that family to save potentially $843 per year with no change

care events that may arise. Families also have the option to contribute additional monies above the $833 to cover routine costs that are covered

Benefi ts Marketplaces

individual employee. They provide a consolidated health portal integrating

comparison tools and integrated access to health care reimbursement

insurance.

Carrier Benefi ts

coming online, many providers are searching for ways to reduce costs.

currently born by the carrier.

Universal Electronic Enrollment

employers but the relationship is typically one-to-one between the employer and the carrier. As such, carriers have been reluctant to offer

associated with managing thousands if not hundreds of thousands of

the responsibility of managing the hundreds of thousands of individual

increased electronic enrollment.

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

providers. It provides a single invoice to the group and remits premium

commissions payments are two large cost items in any carriers operating

The Good, the Bad and the Healthy

thing is clear: individuals and their employers continue to feel the crunch of increasing health care costs. There are certainly many potential options

available today and promise to deliver at least some relief. As the ancient proverb says, “A bird in the hand is worth two in the bush.”

U.S. Employer Data - Number and Size2010 U.S. Census Data

-

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

4,000,000

0-4

5-9

10-1

415

-19

20-2

425

-29

30-3

435

-39

40-4

445

-49

50-7

475

-99

100-

149

150-

199

200-

299

300-

399

400-

499

500-

749

750-

999

1,00

0-1,

499

1,50

0-1,

999

2,00

0-2,

499

2,50

0-4,

999

5,00

0 +

# of

Em

ploy

ers

Employer Size

-

5,000,000

10,000,000

15,000,000

20,000,000

25,000,000

30,000,000

35,000,000

40,000,000

# of Employers

# of Employees

Defined Contribution Model, Private Exchanges Shifting

Power to ConsumersBY DAVID URBANIAK » PRODUCT MANAGER » EVOLUTION1


Defined Contribution—Why Now?

resulting from the passing of the Patient Protection and Affordable Care

of health care, have been catalysts for businesses to reexamine their health

care ecosystem. Another factor to consider is an emerging, technology-rich

environment enabling new and effective ways for consumers to shop for

used to pay for these plans. Consider this:More than 85 percent of the world’s online population has used

Four out of 10 large companies offer a single web-based portal access to employees for a wide variety of information—

Ninety-one percent of consumers said researching products

Since the concept of using dollars provided by an employer to

help consumers navigate their insurance plan will be critical. The tools need to illustrate the employee’s coverage options, while at the same time

Technology offerings that include planning, budgeting, consumer-decision support tools and the facilitation of electronic premium payments, all in

entry.

an evolution of consumer-directed health care plans such as a health savings account

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

reporting features for administrators and

can expect to see even more advanced technology solutions. This is good

According to health care insurer

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

retirement, and investments, found 56 percent of employers are

employees and/or retirees.

their full-time employees on Jan. 1, 2013.

months. A 2011 McKinsey survey of 1,300 employers found 30 percent will

in the years after 2014.

Health Insurance Exchanges: A New Household Term

the same coin. Private health insurance exchanges as a component to

A private exchange is a private business owned and operated by

generally consists of an online shopping experience for health care, dental,

and compare services—similar to how consumers today shop and compare

and arrival times. With an exchange, consumers are able to select and compare critical insurance plan factors to suite their particular family’s


C

opportunity, a variety of business entities are launching their own private

consulting firm Mercer announced in January it was building a health insurance exchange for employers.

Wal-Mart also is investigating the idea of building a private health insurance exchange, which would be geared toward small businesses. Wal-Mart would use its size as leverage

competitive and available to a broader base of companies and individuals.

capabilities within the individual, small group, large group, and/or retiree

including distribution channel strategy, product offerings, and robust tools that integrate with wellness, educational materials, and consumer-driven health care account platforms. Common ways to segment are:

These exchanges are generally promoted by a single carrier such as BlueCross BlueShield and target employers who wish to continue to play an active role in both the selection of insurance carrier and plan design.

employee group or individuals.These exchanges typically offer

consultant or administrator. These exchanges offer a broad array of insurance plan types and plan designs. Employers,

selection for their employees, gravitate to this model.

Private Versus Public Exchanges The private exchange world is fully functioning today, and is not to

be confused with the public exchanges that are still being created due to mandates by PPACA. In the “pay or play” concept, private exchanges allow

Whereas the public exchange will support government-funded health

game. The PPACA mandates the creation of government-funded health

insurance exchanges. A public exchange is a health insurance exchange run by a government or government contracted agency. These “public” exchanges will allow individuals, families, and small employers to purchase health insurance and, for those with incomes between 133 and

and cost-sharing government subsidies. By Jan. 1, 2014, public run exchanges are scheduled to begin

new revenue stream for insurers. Public health insurance exchanges will

be worth nearly $60 billion in premium revenues in 2014, according to PwC

are trying to get a true sense of how exchanges will operate.

gave four more states the approval to set up their own exchanges. Idaho, Nevada,

have been granted approval to set up state-run exchanges. So far temporary federal grants, totaling $964 million,

Currently, public exchanges at the state level appear to be in various phases, with some states already putting their exchange plan into action

around an all-encompassing regulation. Minnesota, for example, recently unveiled legislation that will lay the

forward on its state exchange, but faced a disagreement over how much

out of a state exchange and instead have chosen to participate in a federal

end up operating exchanges in at least 32 states. The deadline for states to declare their intentions to participate in the federal partnership exchange was Feb. 15.

In Conclusion

challenging, trying to ensure every American fully understands and

demanding. In the coming months and years, employers and consumers will face many education hurdles.

industry begins to plan and respond to the mandates found within the

health insurance model will, without a doubt, shift the entire industry

we educate ourselves and fully understand the impacts of this model.

Currently, public exchanges at the state level appear to be in various phases, with some states already putting their

exchange plan into action while others are just beginning to consider how they will get

their arms around an all-encompassing regulation.


Tthat are to manage standardized, state-regulated U.S. health care

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.

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

will be eligible for subsidies as well. But how much can be really processed

The Role of a Customer Service CenterInformation from existing private exchanges indicates less than half

of insurance plan shopping and enrollment activities are fully transacted

an exchange website but ultimately call a customer service representative. In terms of ongoing costs, customer service center operations, not technol-

represent the largest ongoing expenditure after the development and imple-mentation of the technology and initial launch cost.

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.

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

in the private sector. Most of the general public doesn’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

als and small group businesses. Software solutions will integrate many aspects of health insurance delivery—including a consumer portal, eligibility

determinations,

enrollment, and billing administration. Service centers have the potential to greatly

perception of the new law. They must include an integrated

provide effective personalized support to facilitate enrollments

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 exchange’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

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.

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

personnel who can assist with the eligibility and enrollment processes.

Public Exchanges Must Answer Multiple Questions Under Tight DeadlinesBY CRAIG TOBIN » FOUNDER, MANAGING DIRECTOR » EVENTUS SOLUTIONS GROUP


Tightly Integrated Customer Contact Just in Time State exchanges must ensure the service center is a “designed in“

rather than “bolted on” 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.

center operations with an outsourced service center solution. The states will

built-in quality control mechanisms. Failing to identify the right customer service center strategy and partner early in the process will increase costs

compromising their solution.

Selecting the Right Outsourced Service Center

service centers may not easily integrate into current state-managed contact center operations. The right outsourced service center, when selected and

and technologies—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.

impact the success of the state’s exchange:

meets contractual service levelsProven contact center communication technologies in place to ensure capacity and reliability

cost-effective operations. Transparency and visibility into real-time reporting and historical

analyze data for this new program. The ability to adapt and

necessary changes prior to the second open enrollment period

term sustainability that will be required by Jan. 1, 2015

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

and management of your service center partner will include the following elements:

solicitationUnderstand your strategy around the technology to enable the

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.

technology experience and ideally has negotiated previous outsourcing contracts.

pricing impacts in order to gain visibility into the investment required to maintain long-term sustainability

behaviors and desired outcomes.

service delivery

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

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.


Are You Ready to Sell Dental Benefi ts in New Health Care

Reform Environment?


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

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

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.

Current Market Overview

offered through large group employers while small group employers, with

are covered under individual dental policies;; the rest are covered through

Overview of Dental Markets— A Work Still in Progress

penalty. For large groups and public programs, there are no

exchanges and with all small group or individual policies.

requirement.

medical plans and separate dental plans may provide the required pediatric coverage inside the exchanges;; 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

or less employees. This will move an additional 9 percent of the dental

At press time, 19 is the proposed federal minimum age for the pediatric dental coverage provisions of ACA. Unless regulatory changes

in medical coverage. There also are proposed rules which establish a

limit on deductibles for medical policies is $2,000 for individuals and

annually for a family of four and $6,250 annually for an individual and

to be “reasonable” and is proposed to be $1000.

About 98 percent of children have dental claims of less than $1,000 per year. Under a dental plan, they will have only a few hundred dollars

sharing could be substantially higher.

Challenges and Opportunities

selling dental coverage, and sorting out when such coverage is duplicative of the required pediatric dental coverage offered as part of medical plans

Because there will be potential overlap and gaps in policies, small

At the beginning of 2013, many questions still remain. The National

.


ACA QUICK FACTSMarkets affected:


vision, for example, employers are already starting

vision plans will need to change in terms of structure, coverage and costs to both them and

the anticipated impact of health care reform on the

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

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

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

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.

“pediatric vision care” but has left it to the discretion

defaulting to a federal plan. What’s covered by these plans varies

to state. For example,

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

A Game Changer for the Allowance-based Model

Aside from mandatory pediatric vision coverage, health care reform also will have a

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 contacts—allowing freedom of choice, but placing a limit on the total exposure for the plan. Consider that PPACA mandates no

requirement could really stir things up if materi-

be interpreted as meaning patients will have their

the trimmings.

selection of quality glasses, but would limit the ability of patients to buy high-end designer frames.

industry—one that you may have heard about recently—is the debate over whether and how stand-alone vision plans can participate in the exchanges. Under PPACA, pediatric essential health

as part of an employee’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

“essential”. This will help ensure a family can

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

In addition, several employers have already raised questions about whether the new minimum age of covered dependents under PPACA will

Under the law, medical plans must allow dependent children to remain on their parents’ medical plan until age 26, though they lose access

traditionally had similar dependent rules to medi-

modifying coverage rules to allow an employee’s dependent children to be covered on the vision plan until age 26 to stay parallel to the medical coverage.

A Silver Lining AheadThere 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

point is a practical option. While we have yet to see the result of efforts

patient while some of the issues raised by the

Plus, a silver lining to consider is that more

powerful wellness tool and way for employers to improve their bottom line.

How Health Care Reform Will Impact Vision Benefits

BY JEFF SPAHR » PRESIDENT, VISION BUSINESS » WELLPOINTWprofessionals, your mind probably darts to the impact of the

have its greatest effect in this area.


How Health Care Reform Will Impact Vision Benefits

With health care reform designating vision

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

or delay these conditions—before permanent vision loss or other side effects occur.

being able to provide quality vision coverage for themselves and their children. After all, according

-

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-

The bottom line—employers should remain committed to do what’s right in terms of offering quality vision care and vision wear to employees

and their children, regardless of the outcome of health care reform measures.

time to truly understand what is covered in their vision policy.

Finalists 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.

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.

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

benefits to comply with new standards and therefore cut costs or raise prices elsewhere.

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.

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.

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.

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.

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.

Vision for Tomorrow: Insights from the Transitions Academy HR / Broker Panel DiscussionBy Smith Wyckoff, Transitions Optical, Inc.



FLORIDA BLUE » CLEVELAND CLINIC FLORIDA » HIGHROADS » WELLMARK BLUE CROSS BLUE SHIELD » HEALTHWAYS » HARVARD PILGRIM » CASTLIGHT » TOWERS WATSON

Florida Blue and Cleveland Clinic Florida Create Accountable Care Arrangement

Florida Blue, Florida’s Blue Cross and Blue Shield company, and Cleveland Clinic Florida are proud to announce the execution of a Letter

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

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.

“Cleveland Clinic has been a leader in providing high-quality health care at a lower cost,” says Bernie Fernandez, M.D., CEO of Cleveland Clinic Florida. “Our organization is structured around quality

initiative.”The accountable care program between Cleveland Clinic and Florida

Blue will utilize a value-based compensation structure and serve as another example of Florida Blue’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.

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

Management System. The new, SaaS-based solution automates plan design management and eases the compliance burden for today’s health insurance payers.

“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,” says Michael Byers, CEO, HighRoads. “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.”

Today’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

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 holistically—rather than managing individual documents—HighRoads enables payers to generate

Blue Zones Project Demonstration Sites NamedWellmark 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

demonstration site communities in Iowa with populations greater than 10,000 citizens. Nine additional communities with populations less than

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. !Most recently, Dr. Compton served as vice president of business intelligence for DentaQuest, one of the nation’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. Haughom’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.

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 company’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

HEALTHCARE CONSUMERISM SOLUTIONS


10,000 citizens were named demonstration sites in October 2012 for a total of 19 communities currently working formally towards Blue Zones

the Blue Zones Project in Iowa,” says Ben R. Leedle, Jr., Healthways president and CEO. “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.”

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

2014. The progress of all the large demonstration site communities will be

daily assessment of U.S. residents’ health and well-being.

Harvard Pilgrim Health Care Selects Castlight Health to Help Find High-quality, Affordable Health Care

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 Castlight’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.

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

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 country’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 Castlight’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 Watson’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.

“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,” says Bryce Williams, managing director for Exchange Solutions at Towers Watson. “It also creates public exchanges, or marketplaces, as a mechanism for individuals to obtain health plans.”

Dental of Minnesota’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 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 therapy—the first state to allow for this new type of provider—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 HCSC’s policyholders. He also will be the clinical executive responsible for the strategy and oversight of the company’s medical policies, quality improvement, and performance measurement programs delivered by HCSC’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. Haughom’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.

FLORIDA BLUE » CLEVELAND CLINIC FLORIDA » HIGHROADS » WELLMARK BLUE CROSS BLUE SHIELD » HEALTHWAYS » HARVARD PILGRIM » CASTLIGHT » TOWERS WATSON

Oswald

WWW.THEIHCC.COMWHO’S WHO PROFILES


HSA/HRA/FSA TECHNOLOGY: ADMINISTRATION & MANAGEMENT

TSYS Healthcare® provides end-to-end strategic payment solutions for consumer directed healthcare. We partner with benefits administrators, 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

TSYS [email protected]

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.

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

HSA / HRA / FSA ADMINISTRATION AND FINANCE

EVOLUTION1, [email protected]

WageWorks helps employers

support consumer directed

pre-tax benefit programs,

including health care

(FSA, HSA, HRA), wellness

programs, commuting and

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 / HRA / FSA ADMINISTRATION AND FINANCE

WAGEWORKS1100 Park Place, 4th Floor San Mateo, California 94403United States of America

888-9905099www.wageworks.com

HSA ADMINISTRATION & FINANCE

At HSA Bank, we’ve been helping businesses optimize their health care spending for over 15 years. We offer unmatched service and expertise when it comes to health-based savings accounts. You can count on our dedicated business relations team for turnkey 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 BANK605 N. 8th Street Suite 320Sheboygan, Wisconsin 53081United States of America

800.357.6246www.hsabank.com

WWW.THEIHCC.COM WHO’S WHO PROFILES


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

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.”

DATAPATH, INC.1601 WestPark Drive, Suite 9Little Rock, AR 72204

501.296.9990www.dpath.com


LifeSynch changes behaviors to improve lives. Our approach integrates care of the mind and body to enhance health, increase productivity and minimize unnecessary medical expenses. Built on a solid foundation of understanding human behavior and how to motivate behavior change, we deliver proven outcomes through:

“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,

LIFESYNCH2101 W. John Carpenter FrwyIrving, Texas 75063800-207-5101www.lifesynch.com

TOTAL POPULATION HEALTH MANAGEMENT

Proven methods that lead to increased engagement and sustained behavior change.

Clinicians and coaches who provide personalized attention and form trusted relationships with members.

Customizable programs that easily incorporate into existing benefits and services.

Scientifically proven best-practice guidelines to proactively manage care.

Scalable, user-friendly technology.

At Flex, we believe in making health benefits more affordable for everyone. For 25 years, we have enabled thousands of clients to make their health care dollars go further with our consumer driven plans and benefits administration services, including: Flexible Spending Accounts (FSAs) Health Reimbursement Arrangements

(HRAs) Health Savings Accounts (HSAs) Transit/Parking Reimbursement Accounts (TRAs) COBRA Administration 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.


FLEXIBLE BENEFIT SERVICE CORPORATION (FLEX)10275 W. Higgins Road, Suite 500 Rosemont, IL 60018

+1-888-353-9178 [email protected] www.flexiblebenefit.com

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. Corporations: These will give you a far greater ROI than your wellness program while saving your employees thousands of dollars a year. Differentiator: Telemedicine Services: offering the entire family unlimited calls with no consult fees

24/7/365—anytime from anywhere Additional Health Benefits: offering significant savings for pharmacy, dental, vision,

medical advocacy, travel assistance, telephonic counseling (EAP) and more Turnkey Program: billing, administration, fulfillment, call center,

marketing HealthPerx benefits complement any and all existing benefit plans.

! Je" Marks, CEO

HEALTHPERXJeff Marks, [email protected]

Direct: 205 222-4062Toll Free: 888 417-6187www.hperx.com



FSA/HRA/HSA/TRANSIT/COBRA: ADMINISTRATION & MANAGEMENT

efl exgroup (efl ex) is a nationwide administrator of pre-tax benefi ts and COBRA. Committed to providing fast answers, fast claims, and web self-service, we set the industry standards for service. With a customer focus and Lean Six Sigma methodology, we don’t talk about service, we prove it. See our metrics at efl exgroup.com.

“efl exgroup’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 efl exgroup is simply the best!”

! Kimberly Adams, Southeast Energy Assistance [testimonial]

efl exgroup2740 Ski LaneMadison, WI 53713

877.933.3539 ext 300 www.efl exgroup.comefgsales@efl exgroup.com

HEALTH DECISION SUPPORT TOOLS

Castlight Health enables employers, their employees, and health plans to take control of health care costs and improve care. Named #1 on The Wall Street Journal’s list of “The Top 50 Venture-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.

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

CASTLIGHT HEALTH85 Market Street, Suite 300San Francisco, CA 94105

415.829.1400www.castlighthealth.com

PROFESSIONAL DEVELOPMENT

Health Insurance 101: An Orientation is a new, fl exible 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 fi t your organization’s specifi c learning requirements.

AMERICA’S HEALTH INSURANCE PLANS 601 Pennsylvania Ave., NWSouth Building, Suite 500Washington, D.C. 20004Lindsey Miranda Canaley

Tel: 800.509.4422Fax: 202.861.6354 [email protected] www.ahip.org/courses

HEALTHCARE DATA ANALYT ICS

Med-Vision delivers health-plan ris k management and wellness strategies to help employer groups achieve optimal employee health. Med-Vision’s healthcare data analysis tool, Med-View, guides employers in mitigating health risks. With 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

MED-VISION LLCConnie Gee, Vice [email protected]

813-205-1577www.med-vision.comwww.med-view.net



HEALTH INCENTIVES

MedEncentive offers a

patented, web-based

incentive system that’s been

independently validated

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

embraced by users.

MEDENCENTIVECecily HallExecutive Vice President

[email protected]

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.

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

HEALTH ACCESS ALTERNATIVES

WE CARE TLC120 Crown Oak Centre DrLongwood, FL 32750

800.941.0644 [email protected]

ExperienceLab has created a breakthrough, patented communication program that saves employers money by increasing adoption and usage of consumer directed health (CDH) insurance plans among their employees. CDHCentric, sold on a subscription basis, 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

CDHCENTRIC507 S. 8th Ave. Bozeman, Montana 59715


EMPLOYEE COMMUNICATION AND EDUCATION

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

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.”

TRANSITIONS OPTICAL9251 Belcher RoadPinellas Park, FL 33782

800.533.2081 ext. 2262www.healthysightworkingforyou.org

SUPPLEMENTAL HEALTH




MasterCard (NYSE: MA),

is a global payments and

technology company.

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.

MASTERCARD WORLDWIDE2000 Purchase St.Purchase, NY 10577-2509

HEALTH ACCESS ALTERNAT IVES

Carena provides 24/7, on-demand access to health care by phone, webcam, and house call. Seattle-based Carena is committed to delivering the best health care experience possible. Its technology-enabled care delivery model provides on-demand access to health 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

CARENA, INC.1525 4th Avenue, Suite 300Seattle, WA 98101

800.572.2103www.CarenaMD.com [email protected]

TOTAL POPULAT ION 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’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

ORRIANT9980 South 300 West Ste. 100Sandy, Utah 84070

801.574.2603 www.orriant.com [email protected]

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

Workable Solutions is based in Orlando, FL and provides a full array of employee benefit solutions including HSA, HRA, FSA and commuter accounts, COBRA administration, and benefits administration outsourcing. They offer a comprehensive benefit exchange 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.

WORKABLE SOLUTIONS, LLC7120 Lake Ellenor Dr.Orlando, FL 32809

800.946.6342Fax: 407.540.1749www.workablesolutions.com



BENEFIT ADMINISTRATION/PRIVATE EXCHANGES

Since 1988, CieloStar (formerly OutsourceOne) has helped brokers, employers and employees navigate the ever-changing world of benefits. Now, with the dawn of “Defined Contribution Health Care” we are again on the leading edge. With a team of industry thought leaders, CieloStar makes navigating healthand benefits choices 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

CIELOSTAR530 U.S. Trust Building730 Second Avenue SouthMinneapolis, MN 55402


HEALTH DEC IS ION SUPPORT TOOLS

FSAstore.com is the only one-stop-shop exclusively stocked with FSA eligible products and services. At FSAstore.com, consumers have access to more than 4,000 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#

FSASTORE.COM244 5th Avenue, Suite J-257New York, NY 10001

888.FSA.1450 (372-1450)

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.

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.

TRUVEN HEALTH ANALYTICS6200 S Syracuse Way, Suite 300Greenwood Village, CO 80111

734.913.3000

TOTAL POPULAT ION HEALTH MANAGEMENT

Level1Diagnostics uses new tools to evaluate employees’ cardiovascular healthHeart disease is the number one killer in the U.S. and costs millions of dollars in medical care and time lost from work. Detection and prevention is the key to heart health. Level1Diagnostics 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.”

!Dr. Steven Helschien, Founder, Level1Diagnostics

LEVEL1DIAGNOSTICS11722 Lightfall CourtColumbia, MD 21044

Dr. Steven Helschien, FounderSales: Penny Aleo, Executive [email protected]

Dr. Steven M. HelschienFounder and CC&BW

www.level1diagnostics.com410-707-5667 ! [email protected]

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

ADVERTISING CONTACTS

AHIP ........................................................ 46

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

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

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

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

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

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

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

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

efl exgroup ................................................ 46

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

Flexible Benefi t Service Corporation ...........45

FSA Store ...................................................49

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

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

HSA Bank ........................................... 22, 44

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

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

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

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

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

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

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

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

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

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

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

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

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

Wiser Together ................................... 20, 50

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

ADVERTISING INDEX

404.671.9551

CEO/PUBLISHER

Doug Field @

MANAGING DIRECTOR

Brent Macy

ACCOUNT MANAGERS

Joni Lipson

Rogers Beasley

REPRINTS

Rogers Beasley

R E S O U R C E G U I D E



EMPLOYEE ENGAGEMENT TOOLS

Under the CIVA (CodeBaby Intelligent Virtual Assistant) brands of benefi ts and health advisor, CodeBaby improves the healthcare consumer experience and optimizes online self-service on any web-based platform or device with absolutely no IT disruption. Benefi ts advisor offers guidance and self-service options that help consumers and organizations alike to make better decisions about benefi ts selection. Health advisor engages new patient visitors on hospital or offi ce 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 benefi ts and health advisor solutions are industry-leading models that help consumers and organizations more effi ciently navigate complex health benefi t exchanges and patient portals. “

-Dennis McGuire, CEO

CODEBABY CIVA111 S. Tejon St. Suite 107Colorado Springs, CO 80903877.334.3465codebaby.com/[email protected]

HEALTH DECISION SUPPORT AND COST-SAVING TOOLS

WiserTogether Inc., helps patients

choose the right care at the time. It

offers an innovative online treatment

selection & shared decision support

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.

! Praveen Mooganur, COO

WISER TOGETHERPraveen Mooganur

202.276.3074

[email protected]

© 2012 BBY Solutions, Inc. INCENTIVE POINTS

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.

THEY JUST MIGHT WHISTLE WHILE THEY WORK

11836-5_RZIP_Music_Ad_CDHC.indd 1 7/17/12 12:13 PM

© 2012 BBY Solutions, Inc. INCENTIVE POINTS

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.

THEY JUST MIGHT WHISTLE WHILE THEY WORK

11836-5_RZIP_Music_Ad_CDHC.indd 1 7/17/12 12:13 PM

Engaging consumers to make informed health care decisions UnitedHealthcare’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. !at’s why our plans o"er:

and even doctor; as well as expenses related to possible care paths

tools to implement and successfully maintain its consumer-driven health plans.uhctogether.com/CDH or call 1.866.438.5651.

myHealthcare Cost Estimator is currently available to many UnitedHealthcare members, and will launch in additional markets throughout the remainder of the year.©2012 United HealthCare Services, Inc. Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc. or their affiliates. Health plan coverage provided by or through a UnitedHealthcare company. UHCEW506202-002

READY. SET. GROW HEALTHY. UHCTOGETHER.COM/CDH

healthcare consumerism solutions jan/feb '13

Documents

public exchanges

health claims

term health care reform

value of private exchangesmuch

impact vision benefits

employee vision plans

case of vision

employee medical benefits