open enrollment season approaching this fall for Employers,
Medicare and Health Insurance Exchanges, what major concerns or
observations are in the forefront from your perspective?"
Better Health Technologies, LLC
In the next year, the big issue will
be around benefits adequacy, i.e., lack of coverage and high
out-of-pocket expenses incurred due to high deductibles,
co-pays, exclusions, etc. My shorthand for this is "Swiss
cheese health insurance-so, so many holes."
canary in the coal mine is a
recent letter signed by 333
patient advocacy groups to HHS Secretary Sylvia Burwell. The
Letter describes three concerns around benefits adequacy,
"especially (for) those with chronic health conditions": 1)
Limited Benefits, 2) High Cost-Sharing, 3) Transparency and
The issues here are tough and not
amenable to easy, quick solutions. Curious about the
details? Read my
blog post on this topic.
keep your doctor AND you get Swiss cheese health insurance."
That's NOT a very uplifting tagline for the newly insured.
Board of Directors,
Epstein Becker & Green, P.C.
This question spans at least three
markets -- commercial, Medicare Advantage and Exchange
mediated products. There are different dynamics at work in
each. In the commercial market employers are watching to see
whether the resumption of the climb of medical cost trend
will, in conjunction with the Cadillac tax, move them closer
to a defined contribution/private exchange choice.
In the Medicare Advantage
market, plans are battling for higher star ratings,
absorbing cuts and digesting the application of MLR rules.
In the exchange world, payors are seeking better definition
of the risk pool while dealing with shifts in the
However, what is cross cutting among these markets is the
open question of whether the medical expense line can be
moved by value based purchasing and whether consolidation in
markets will cause price increases that eat into any gains
from those developments.
Self-funded employers and payors with insured products
(commercial, MA or exchange) have shared interest in the
proliferation of value based payment methodologies --
although their spread is inhibited by the work entailed in
framing and negotiating the terms, limited data capabilities
and lack of consensus as to what the "low hanging fruit" is
among risk methodologies to be implemented.
Of equal concern is the inability of
limited (single product or payor) innovations to "move the
needle" and capture provider attention given the diffusion
of patients across insured arrangements. Absent additional
progress in "all payor" value based purchasing the issue for
all these markets could be the absence of fundamental
positive improvement in cost trend.
HealthCare Strategy Consultant
As healthcare transitions to a
consumer-driven environment, all constituents must make the
necessary adjustments to support individual accountability
in selecting the benefits that are most appropriate for
their coverage needs. Fundamentally this translates to
infrastructures with sophisticated decision support
resources and communication strategies that educate
employees, Medicare beneficiaries, and individuals on their
What's top of mind for me as
open enrollment approaches is are consumers educated on
their options and how to make the best coverage decision for
their needs. As employers aim to better control costs of
providing healthcare for their employees, there is a focus
on the redesign of employee total rewards packages,
specifically related to health benefits, wellness, and
Educating employees on benefit
options and providing appropriate incentives to enroll into
higher value benefit packages is key to promote the
"right-sizing" of benefits. This becomes increasingly
important as exchange marketplace adoption accelerates
putting insurance purchasing decisions in a retail-setting.
Providing the right tools and
resources to improve the financial literacy and
out-of-pocket implications of benefits is critical to the
success of exchanges. The exchange model is still relatively
early in scaling but technology that offers robust and
sophisticated decision support will facilitate open
enrollment as employee benefit distribution models become
Principal, KBM Group
It's all about the customer!
For consumers, open enrollment means a series of
challenging decisions. It's a time to shop, compare, switch
or stay with a current plan. But let's face it, on a good
day health insurance is a confusing, bureaucratic labyrinth.
And for the most part, consumers are not confident insurance
buyers. A recent Urban Institute survey shows that half of
individuals with health insurance don't understand basic
insurance concepts. For those going into the buying process
without insurance the knowledge gap deepens dramatically.
Beside the avalanche of acronyms (IEP, OEP, AEP, SEP), open
enrollment brings a bombardment of direct-to-consumer
messaging - TV commercials, direct mail, online banner ads,
etc. all making bold promises and playing one-upmanship with
competitors. As health plans place the burden of choice
squarely on the shoulders of the customer-selecting the
right plan, budgeting for premiums, and choosing provider
networks-consumers want a trusted advisor as they step into
the role of prudent health insurance buyer.
Trust is a key word here. In a recent healthcare survey of
34,000 consumers probing their relationship with and
attitudes toward healthcare insurers and providers, only 22%
said they trust insurers and even fewer, 12% say they rely
on insurers as a source for health advice or
information...sobering statistics for insurers looking to
influence prospects and customers about coverage options and
If we expect consumers to take greater personal
responsibility and stay involved in health benefit
decisions, they need to be educated and engaged. Every
touch-point throughout the healthcare customer journey must
be driven by an integrated communication stream that deepens
engagement through useful, personalized interactions and
customer value exchange. Informed consumers will drive
better upfront economic decisions and ultimately, better
health and financial outcomes.
Health insurance brands are now inseparable from their
ability to engage the customer and build trust. They must
provide customers a reason to engage by guiding them through
healthcare's maze of choice and rewarding them with
interactions that do the right thing for their healthcare.
Success hinges on setting realistic expectations, clarifying
rules of engagement, and providing continuous customer
education throughout the member lifecycle. It means
delivering responsive, understandable content to the
consumer on their terms, through channels they consider most
Chief Strategy Officer
The Affordable Care Act (ACA) is preparing to open the
second act and will be more organized and structured than in
year one. Because
the Employer Mandate provisions were delayed for a year,
last fall's open enrollment was a real beginning. At this
point, it appears this year employers will actually face
penalties and be required to report on the status and
enrollment of their employees to the IRS. Plan sponsors who
are not in compliance will need to get things together now.
Employers should already have a plan in
place to track their variable hour employees and decide
which method they will use - either the lookback or
month-by-month approach - to determine which employees must
be offered employer health coverage. There are a number of
tools for employers to handle tracking, with the major
considerations for choosing being cost, available internal
resources and compatibility with payroll systems.
Keenan, has developed arrangements with two organizations to
offer this service.
As the IRS issues the final forms and instructions
for Code Sections 6055 and 6056 reporting, employers will
also have to determine where the data elements will come
from to complete these reports. In California, new
legislation was enacted to extend grandfathered plan
protection to groups under 50 employees for another year.
The public sector and health care
employers we work with have employee segments that are not
always benefit-eligible. As many of these individuals
endured the challenges and wait times in dealing with the
exchanges and their sometimes balky web sites, employers may
expect that enrollees will have numerous questions. It is
estimated that a number who enrolled in an exchange plan
during the last open enrollment will make a change for 2015,
with considerable focus on dissatisfaction with provider
networks which have been expanded in a number of cases.
It does not cost
them anything additional to use the assistance of a
certified Agent or Broker and they may better avoid delays
and slow response times as well as gain valuable information
in making these decisions for members and their families.
Public agencies also need to consider
their retiree participants and how options available through
a Medicare Exchange can help to mitigate their retiree
liabilities for health benefits. A new Exposure Draft from
the Governmental Accounting Standards Board (GASB) includes
provisions that public agencies will need to report unfunded
liabilities, not under a qualified trust, on the face of
their financial statements. Using a defined contribution
approach, such employers can direct their retirees to a
Medicare Exchange and effectively reduce their liability.
We at Keenan offer Futuris Care, our retiree
exchange, which is an increasingly popular offering which is
one of the fastest growing areas of our business.
Advanced Illness though Population Health Management, September
Medicaid Transformation and Provider Collaboration Web Summit,
September 19, 2014
ACO Market Consolidation and Antitrust Issues, October 3, 2014
ACA Plan Sponsor Roadmap for 2015 - Current and Upcoming
Compliance Challenges, October 10, 2014
Benchmarking Bundled Payments - Medicare PAC Utilization
Benchmarks, November 13, 2014
Accountable Care Web Summit, December 11, 2014
Post-Event Materials from Past Events
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