Advisers must move ‘faster and stronger’

It is time for brokers and consultants to face the much talked-about upcoming challenges head on and move forward “first, faster and stronger” than their competitors. The goal is to make clients understand that the cost of doing nothing might be the “most expensive, more detrimental thing to a business,” a former adviser said Monday.

Speaking at the 6th Annual Employee Benefit Adviser Summit at the Hyatt Regency, Kevin Trokey, president and chief executive of St. Louis-based consultancy Benefits Growth Network said that because the challenges are so difficult, brokers can differentiate themselves from the competitor by tackling them now.

Of course, it’s not the first time advisers have faced a looming problem. Recalling the mid-1990s prospect of nationalized health care, former New York Governor Eliot Spitzer going after income and the Internet, Trokey says that “most of these things came with a glancing blow [and] nothing delivered that knockout punch.”

But that punch is coming — in the form of health care reform and MLR’s and that requires facing your challenges by taking control, he says. Brokers and advisers often couldn’t take control in the past, since the products they sell are typically from insurers, who control the rates, for example.

To take control you need to partner with the human resources department, “which has the potential to truly be that strategic driver in an organization.” Yet, when companies realized that HR could change their companies and create the experience employees need, they did not find strategic thinkers, Trokey says. Instead the department consisted primarily of administrative staff. “They weren’t prepared to take on this [strategic] role with the organization,” he says.

That “creates opportunity for us,” Trokey adds. “If you get yourself aligned with [a client’s] strategic vision, that’s when you go from being an expense to being an investment. . . . [It’s] your time to come in and fill the strategic void and when you fill that strategic void, that’s something you can control and take control of how you get paid,” he adds.

Everyone benefits when you can get HR connected, which all starts with building a plan. “If you can’t commit to that, I don’t know what to tell you,” he concludes. “The cost of doing nothing at this point – that could be detrimental.”

By Brian M. Kalish

Dutton to Continue on NAHU Legislative Council

UBA Board Member Ron Dutton of RJDutton Inc. has been invited to continue his participation on the NAHU Legislative Council. Dutton joined the council in 2010.

The Council, composed of 13 members nationwide, works to develop market-based solutions that improve the accessibility and affordability of employee benefits and insurance. The Council also guides grassroots efforts to advocate sound policy during the legislative and regulatory process, according to NAHU.

The Council also provides guidance to NAHU’s Board of Trustees and promotes issues among NAHU members and its chapters.

Investing in Employee Health Produces Health Benefits for Employers

It is possible that in the United States, with the continued debate on health care reform and the emphasis on eating well, staying fit and losing weight, employers are more aware that health is connected to productivity, but we cannot say for sure. Some companies might pay lip service to the notion that employee health can increase profits, but they may need more convincing before they put company resources behind efforts to improve employee health.

A survey of British employers found that “three quarters of employers (76%) do not correlate employee health and wellbeing to productivity. This figure rises to 86% amongst Finance Directors.” It seems that Finance Directors, who keep an eye on the bottom line, are the most likely to not see the need for an organization to be concerned with employee health, but they are surely not alone and we know this is not just happening in England.

“Simplyhealth’s engaging employees through health and wellbeing report also found that three quarters of employees whose employer cares a great deal about their health and wellbeing describe themselves as very loyal. The failure to correlate benefits with productivity could mean that employers do not fully understand the impact they can have, and are missing a key opportunity to engage with staff.”

An expert from a business school suggests that “…employers would perhaps be wise to consider the most cost effective means to maintaining tangible key benefits, whilst still finding ways to enhance engagement that are less reliant on money.” This is especially true in cases where an organization has to increase employee workloads.

The good news is that you do not have to figure it all out on your own.

Employers stand behind preventive care at the worksite

A new Midwest Business Group on Health survey finds near universal (97%) agreement that employers have a role in offering such preventive care services as screenings and vaccinations.

MBGH conducted the survey among its employer members in anticipation of health care reform’s provision that, effective September 23, new insurance plans must provide preventative care without cost-sharing.

The top three reasons given by employers for providing such services are to reduce medical disability costs and prevent illness (94%), to keep employees healthy (84%), and to keep employees productive (59%).

“Employers are increasingly investing resources in preventive care and wellness programs to reduce health care costs and improve the health and productivity of their employees,” says Larry Boress, MBGH president and CEO.

“We conducted this survey to help employers understand the importance of health management and wellness in managing health care costs and realizing healthy and productive employees. We hope health care purchasers will use the recommendations resulting from this research to increase utilization in areas that will provide the most bang for their buck,” he adds.

Additional survey findings include almost half (48%) of employers utilize a high benefit cap of more than $1,000 to encourage use of preventive services. Those services covered by more than 90% of survey respondents include: annual screenings, well child visits, pap smears, breast exams, prostate exams, colorectal cancer screening and employee assistance program services.

Employers state that the top barriers to get employees to use preventive benefits are a lack of understanding of their value (88%), no motivation to get healthy (56%), and difficulty taking time during the work day (47%).

MBGH recommends that employers encourage employee use of preventive services through an increased focus on education and communication, removal of barriers to access and better alignment of incentives.

Coping with the Rising Costs of Health Care

Due to the escalating costs of medical care and new regulations, businesses of all sizes are struggling to provide employees with attractive benefits at costs they can afford. Business owners concerned about productivity and employee morale may want to consider the following options as you begin planning for 2012.

Increased Transparency
Health care reform has given rise to a lot of questions and uncertainty among employees, so there has never been a greater need to paint a clear picture of what your benefit plan includes and why. Offer details on coverage, costs and the impact these costs are having on your operation.

Listen to Employees
Allow employees to research the different health care options your company provides and when possible, engage them in the decision making process. Some employers have had great success by organizing committees from all employee levels and listening to their input before adopting plan designs.

Promote Wellness
Successful wellness programs not only keep medical costs lower, but they can build camaraderie and loyalty. Access to health risk assessments and incentives or discounts off annual costs when wellness goals are met are things you should consider. Weight loss or healthy eating challenges with proceeds going to charity are fun ways to help your company and your community.

Revisit CDHPs
High deductible health plans with health savings accounts (HSAs) or health reimbursement arrangements (HRAs) are growing in popularity. Along with Section 125 Flexible Spending Accounts (FSAs), these options provide tax savings and increased responsibility to plan participants.

More Employers Using Employee Wellness Incentives

The 16th Annual Towers Watson National Business Group on Health Employer Survey on Purchasing Value in Health Care found that “many employers are taking bold actions, and implementing new health benefit program changes to drive employee and provider accountability.” If you are interested in making a bold move to manage health care costs, you can consider a self-funded health plan that allows you to set parameters for group employee benefits that really work for your business and your staff.

Another way that employers are looking to keep costs in line is by placing some of the responsibility into the hands of employees. Sure, employees have had to cover more costs for their health care, but there are also ways to encourage employees to help lower their own health care costs.

They found that more of the employers surveyed are using wellness incentives and even more have plans to use these incentives in the coming year. Some are rewarding employees for giving up smoking, participating in health-boosting activities and taking part in biometric screening. On the other hand, some are choosing to penalize employees who do not do things like give up smoking, meet targets for weight control or enroll in health-boosting activities. There are even employers who “use a lower-value plan option for employees not fulfilling requirements in health and disease management activities.

Employers remain strongly committed to improving the health of their workforce. Along these lines, many employers are expanding the use of employee incentives to participate in lifestyle coaching, complete biometric screenings and take advantage of other measures (Figure 25, page 15 and Figure 26, page 16 in the report).

Towers Watson notes that more employers are linking benefits, health and productivity by monitoring health programs and looking at results to how they can improve. J.P. Farley can assist your company in creating a successful performance-based wellness program that utilize results to achieve measurable return for the health plan.

Posted by J.P. Farley Corporatio

Putting health coverage within reach

August 29, 2011
To bring health insurance to more Americans, the federal healthcare reform law calls for billions of dollars in subsidies for lower-income households. The law gives states an option, though, that could cut costs while also making the coverage more affordable. Called a Basic Health Program, it would serve as a transitional step between Medicaid and the private insurance plans. A bill by state Sen. Ed Hernandez (D-West Covina) to create such an option in California is pending. Lawmakers should approve it.

The program would give low-income families an alternative to the insurance exchange that California is creating for consumers not covered by employer-sponsored plans or MediCal. Although Washington will subsidize policies sold at the exchange to those earning up to four times the federal poverty level, they may still cost too much for some of the working poor. For example, a single mother making $600 a week in Los Angeles may be hard-pressed to afford the $90 in monthly premiums and co-payments that the exchange’s entry-level plans are expected to cost.

The Basic Health Program created by Hernandez’s bill (SB 703) would bring monthly costs down to about $30 for those earning less than twice the federal poverty level. At the same time, the coverage provided by the bill, which relies solely on federal funds, would cost taxpayers less than the subsidized private insurance plans at the exchange. That’s because the Basic Health Program would pay doctors and hospitals less for their services than private insurers do. Those payments would still be higher than the notoriously low ones offered by MediCal, which should prompt more doctors and hospitals to participate and provide better access to care than MediCal.

Some state officials have suggested that the new program could undermine the exchange by reducing the total amount of premiums it collects and, potentially, leave it with older and costlier customers. But with an estimated 1.8 million people still under its purview, the exchange’s risks and costs would be spread across one of the largest groups of customers in the country. Two new studies also suggest that the Basic Health Program wouldn’t leave the exchange with a group that’s costlier to insure. But if lawmakers want more certainty, they can require insurers to combine both groups into a single risk pool when calculating premiums.

When poor people without insurance require medical care, they tend to receive it in the least efficient and most expensive ways, with the costs borne by everyone else. That’s one of the reasons it’s important to extend coverage to as many people as possible. The Basic Health Program and the state’s new insurance exchange share that goal, but the former would put insurance within reach of more of the working poor. That makes it an important part of the evolving healthcare system, and a good deal for taxpayers.

Make Employers’ Provision of Group Health Insurance Easier, Less Costly

More than half of all Americans receive health insurance through an employer. Let me advance a bold premise: This is not entirely a bad thing. By insuring 150 million of us, employer-based plans relieve government of the burden of funding our insurance and care, allow doctors and hospitals to be adequately paid for the treatment they render, and permit them to supply that care promptly.

My point here is not to argue that the current system doesn’t need fixing – of course it must be improved, and more people need coverage. My point is that in the process of attempting to improve the system, government should acknowledge this: Employer-based coverage has some real virtues, and if Washington is going to be involved in that effort it should facilitate the employers’ undertaking, not make it unduly costly and burdensome.

Additional Burden

Lockton Benefit Group just completed a survey of its 2,500 mostly middle market clients, and 80 percent of the more than 1,000 who responded said they were concerned or very concerned about the additional burdens last year’s healthcare reform law puts upon administration of their group plans. With good reason.

Even prior to healthcare reform the sponsor of a simple group health plan was required, under federal law and regulations, to provide up to 33 different notices, disclosures and reports to enrollees or the federal government. Healthcare reform adds up to 19 new ones, so far. That’s up to 52 notices and reports under federal rules, for a health care plan.

These health plan notices and reports go to different individuals, at different times, often via different means. Some can be combined with others, some can’t. Some must be “prominent,” some in specific-sized font. A few can be posted, most cannot. The employee can be entrusted with some, while others must be mailed home. Some can be provided online, others cannot. Few employers will have to deliver the full 33, but no matter, they must deliver most, and many must be supplied more than once, often annually.

Failure to supply all these disclosures, at the right times, can trigger huge penalties upon the employer, who all the while is endeavoring to remain focused on providing goods or services, and jobs.

Significant Cost

Let’s find some perspective here. These employers are not processing radioactive waste, or engaged in some other hazardous effort where we’d insist they ensure employees understand the deal. We’re talking about sponsoring a healthcare plan.

There is significant cost to these notices and reporting efforts. Washington, when it levies a new notice obligation, usually attempts to quantify the time and cost burden on the plan. Standing alone, the burden of any single notice is not overwhelming. There appears, however, to be no effort to quantify the aggregate burden, and to weigh it against the true value proposition.

Why the monstrous administrative burden? Washington needs some of the reports to do things it’s required to do. Some of these things are actually useful, like helping Medicare save money. And some of the notices to employees – such as COBRA notices – are important enough to outweigh the burden. But the panoply of other notices to employees has long-reached the tipping point where the burden, particularly in the aggregate, outweighs the virtues.

Here’s how I know.

First, I have some modest level of common sense.

Second, Lockton employees have witnessed countless health plan enrollment meetings where these notices literally litter the floor, particularly around the trash can. Are some employees interested? Sure, a few. So let the employer make those notices available online or on a bulletin board to anyone interested enough to look. I’d even be willing to require the health plan booklet to “prominently” tell the reader where to find the notices.

Let’s synchronize the timing of as many of these notices as possible, and not require things like specific-sized fonts. Let the employer consolidate most notices in a single pamphlet or e-file.

Employers are not looking for a “thank you” from Washington, for supplying insurance to employees. But they don’t deserve to be slapped upside the head either. Health plans are costly enough as they are. Let’s restore a little balance, a little sanity to the endeavor, and not give our nation’s employers yet one more reason to throw up their hands and exit the group insurance game.

By Ed Fensholt

Tweaking Health Reform

Large employers are steering clear of Republican efforts to repeal the Patient Protection and Affordable Care Act (PPACA). Instead, they are focusing on surgically altering individual Department of Health and Human Services rule-makings where bureaucrat interpretations of broadly worded healthcare reform provisions could negatively affect company health plans this year. To the extent that new Republican chairs of congressional committees hold oversight hearings to shine a light on imple-?mentation imbroglios, business groups welcome that attention.

“The way the law has been implemented has been a mixed picture,” says Paul Dennett, senior vice president of health care reform at the American Benefits Council. For example, he cites rules denying grandfathered status to plans that made cost-sharing changes after March 2010. Grandfathered plans can ignore some of PPACA’s requirements.

Another current hot spot is how regulations define preventive services, which must be provided to plan members without cost sharing in 2011, says Gretchen Young, senior vice president of healthcare policy at the ERISA Industry Committee.

The interim final rule published last July imposes mandates based on recommendations from the U.S. Preventive Services Task Force, which focuses on services physicians should provide, Young says. “These are ambiguous or unclear with respect to their application to health plans,” she says. Nor is it clear whether employers can apply reasonable medical management techniques and cost-sharing to out-of-network preventive services.

Dennett and Steve Wojcik, vice president of public policy at the National Business Group on Health, agree that federal agencies have shown some welcome flexibility, even prior to the midterm elections. Dennett points to the HHS’ waiving some PPACA requirements for so-called mini-med plans, low-cost, low-benefit insurance offered mostly to low-wage employees. Without the waivers, companies would have eliminated those plans this year and employees would have lost their health coverage, he says.

vBig business groups see a number of positive aspects to healthcare reform, which accounts for their “rejigger, not repeal” approach. PPACA’s proision of $5 billion to help companies fund health insurance for early retirees who are too young for Medicare is one of a number of pluses.

Still, companies evince a smoldering desire to obtain legislative changes to a couple of provisions that don’t kick in for some years, such as PPACA’s requirement that starting in 2018, companies pay an excise tax on what have been referred to as “Cadillac” health plans.

By Stephen Barlas

Employers continue to worry about health costs in 2011, and expect to expand defined benefit plans

With health reform uncertainties, growing health regulations, and ever-increasing costs, employers who sponsor health plans for their workforce will continue to cover active employees. That is, at least until 2017, according to the crystal ball used by Mercer, explained in the Health & Benefits Perspective called Emerging challenges…and opportunities…in the new health care world, published in May 2011.

Note that it’s “active” employees who Mercer expects will retain access to health benefits. For retirees, however, it’s another story. They need to be ready to take on more responsibility, financially and perhaps going-to-market to select coverage, while employers may continue some level of subsidy to help pay for that coverage.

For active employees, thoWith health reform uncertainties, growing health regulations, and ever-increasing costs, employers who sponsor health plans for their workforce will continue to cover active employees. That is, at least until 2017, according to the crystal ball used by Mercer, explained in the Health & Benefits Perspective called Emerging challenges…and opportunities…in the new health care world, published in May 2011.

Note that it’s “active” employees who Mercer expects will retain access to health benefits. For retirees, however, it’s another story. They need to be ready to take on more responsibility, financially and perhaps going-to-market to select coverage, while employers may continue some level of subsidy to help pay for that coverage.

For active employees, though, the “new health care world” that Mercer sees will feature greater focus on defined contribution plans that limit employers’ liability. In addition, these plans will be based on novel benefit designs, health provider networks, population health programs, and “nudges” via carrots and sticks to encourage employees to make sound health decisions.

Mercer’s case for growth in defined contribution plans is 4-fold: the plans would,

Generate savings over time
Be easily administered
Align with pay and benefits
Be transparent and easy to understand.
Beyond 2015, Mercer envisions that employers will be looking to Accountable Care Organizations (ACOs) and new delivery models that improve efficiencies and take on quality for their enrollees.

Health Populi’s Hot Points: Ultimately, Mercer says, “innovation and value will become imperatives.” What will drive both innovation and value will be the ability to align incentives for providers to change clinical workflow and decision making, and engage patients in self-care when sick, and disease prevention and whole health when well. Technology must underpin these efforts: from providers sharing patient data for care management, to workers knowing their numbers and self-tracking. That alignment can only happen when health plans are designed to achieve those ends — that’s where the value is generated. And defined benefit plans, as they have been largely configured to-date, haven’t achieved those outcomes. It’s in the creative ‘nudging’ where the value is born. As user-centered design has worked well in consumer electronics and fast-moving consumer goods, health benefit designers should get close and personal with prospective enrollees to learn just what features would actually move them to co-create their own health.ugh, the “new health care world” that Mercer sees will feature greater focus on defined contribution plans that limit employers’ liability. In addition, these plans will be based on novel benefit designs, health provider networks, population health programs, and “nudges” via carrots and sticks to encourage employees to make sound health decisions.

Mercer’s case for growth in defined contribution plans is 4-fold: the plans would,

Generate savings over time
Be easily administered
Align with pay and benefits
Be transparent and easy to understand.
Beyond 2015, Mercer envisions that employers will be looking to Accountable Care Organizations (ACOs) and new delivery models that improve efficiencies and take on quality for their enrollees.

Health Populi’s Hot Points: Ultimately, Mercer says, “innovation and value will become imperatives.” What will drive both innovation and value will be the ability to align incentives for providers to change clinical workflow and decision making, and engage patients in self-care when sick, and disease prevention and whole health when well. Technology must underpin these efforts: from providers sharing patient data for care management, to workers knowing their numbers and self-tracking. That alignment can only happen when health plans are designed to achieve those ends — that’s where the value is generated. And defined benefit plans, as they have been largely configured to-date, haven’t achieved those outcomes. It’s in the creative ‘nudging’ where the value is born. As user-centered design has worked well in consumer electronics and fast-moving consumer goods, health benefit designers should get close and personal with prospective enrollees to learn just what features would actually move them to co-create their own health.With health reform uncertainties, growing health regulations, and ever-increasing costs, employers who sponsor health plans for their workforce will continue to cover active employees. That is, at least until 2017, according to the crystal ball used by Mercer, explained in the Health & Benefits Perspective called Emerging challenges…and opportunities…in the new health care world, published in May 2011.

Note that it’s “active” employees who Mercer expects will retain access to health benefits. For retirees, however, it’s another story. They need to be ready to take on more responsibility, financially and perhaps going-to-market to select coverage, while employers may continue some level of subsidy to help pay for that coverage.

For active employees, though, the “new health care world” that Mercer sees will feature greater focus on defined contribution plans that limit employers’ liability. In addition, these plans will be based on novel benefit designs, health provider networks, population health programs, and “nudges” via carrots and sticks to encourage employees to make sound health decisions.

Mercer’s case for growth in defined contribution plans is 4-fold: the plans would,

Generate savings over time
Be easily administered
Align with pay and benefits
Be transparent and easy to understand.
Beyond 2015, Mercer envisions that employers will be looking to Accountable Care Organizations (ACOs) and new delivery models that improve efficiencies and take on quality for their enrollees.

Health Populi’s Hot Points: Ultimately, Mercer says, “innovation and value will become imperatives.” What will drive both innovation and value will be the ability to align incentives for providers to change clinical workflow and decision making, and engage patients in self-care when sick, and disease prevention and whole health when well. Technology must underpin these efforts: from providers sharing patient data for care management, to workers knowing their numbers and self-tracking. That alignment can only happen when health plans are designed to achieve those ends — that’s where the value is generated. And defined benefit plans, as they have been largely configured to-date, haven’t achieved those outcomes. It’s in the creative ‘nudging’ where the value is born. As user-centered design has worked well in consumer electronics and fast-moving consumer goods, health benefit designers should get close and personal with prospective enrollees to learn just what features would actually move them to co-create their own health.With health reform uncertainties, growing health regulations, and ever-increasing costs, employers who sponsor health plans for their workforce will continue to cover active employees. That is, at least until 2017, according to the crystal ball used by Mercer, explained in the Health & Benefits Perspective called Emerging challenges…and opportunities…in the new health care world, published in May 2011.

Note that it’s “active” employees who Mercer expects will retain access to health benefits. For retirees, however, it’s another story. They need to be ready to take on more responsibility, financially and perhaps going-to-market to select coverage, while employers may continue some level of subsidy to help pay for that coverage.

For active employees, though, the “new health care world” that Mercer sees will feature greater focus on defined contribution plans that limit employers’ liability. In addition, these plans will be based on novel benefit designs, health provider networks, population health programs, and “nudges” via carrots and sticks to encourage employees to make sound health decisions.

Mercer’s case for growth in defined contribution plans is 4-fold: the plans would,

Generate savings over time
Be easily administered
Align with pay and benefits
Be transparent and easy to understand.
Beyond 2015, Mercer envisions that employers will be looking to Accountable Care Organizations (ACOs) and new delivery models that improve efficiencies and take on quality for their enrollees.

Health Populi’s Hot Points: Ultimately, Mercer says, “innovation and value will become imperatives.” What will drive both innovation and value will be the ability to align incentives for providers to change clinical workflow and decision making, and engage patients in self-care when sick, and disease prevention and whole health when well. Technology must underpin these efforts: from providers sharing patient data for care management, to workers knowing their numbers and self-tracking. That alignment can only happen when health plans are designed to achieve those ends — that’s where the value is generated. And defined benefit plans, as they have been largely configured to-date, haven’t achieved those outcomes. It’s in the creative ‘nudging’ where the value is born. As user-centered design has worked well in consumer electronics and fast-moving consumer goods, health benefit designers should get close and personal with prospective enrollees to learn just what features would actually move them to co-create their own health.

by JANE on 1:28 PM in AFFORDABLE CARE ACT, EMPLOYERS, HEALTH ECONOMICS, HEALTH PLANS, HEALTH REFORM, MEDICAL INNOVATION, PREVENTION AND WELLNESS