employer-sponsored healthcare outlook. agenda state of employer healthcare insurance trends...
TRANSCRIPT
Employer-Sponsored Healthcare Outlook
Agenda
• State of Employer healthcare• Insurance trends• Compliance snapshot• Technology outlook• Recap
State of Employer Healthcare
A shifting landscape
Healthcare• Cost• Community
Rating• Funding• Narrow
Network / ACO
Compliance• ERISA• ACA• ER Reporting
Technology• Ben Admin• Private Exchange• Payroll/HRIS
Employer Sponsored Health Insurance
• ACA is here to stay– Community rating for groups w/less than 100 employees
• Winners and Losers• Reduced choice/freedom• No room for negotiation on cost• No reward for risk management
Employer Sponsored Health Insurance
Carrier– Aetna/Humana– Anthem/Cigna– American “Socialized”
Medicine
Broker– Record Consolidation– New Landscape – Death of mom/pop
Consolidation
Employer Sponsored Health Insurance
• Future of Employer-sponsored healthcare– Seeing a massive migration from fully-insured to self-
insured arrangements• ASO• Captive
– Employers relying more on technology• Reporting requirements• Managing education/communication to support employee
self-service options
– Network Compression
Why the Self-Insured Migration?
Mercer 2011 National Survey of Employer-Sponsored Health Plans
Funding Level Risk Comparison
$0 $ Saved $$ Saved $$$ Saved $$$$ Saved0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
$ Total Spend versus Risk for Employer & Employee
$ Savings Risk
Fully Insured
Level Funded
Captive
Cost Plus
Reference Based Pricing
ASO
3 Primary Self-Insured Options
– Traditional – ASO (administrative services only)• More risk – stand on your own two feet• Purchase claims administrator and stop loss
– Level Funding• Self-insured plan with fully-insured premium
(manual rating does apply)• One carrier/TPA/stop-loss
– Captive• Self-insured for a portion of risk• Share in remaining risk with other captive
members
Captive Health Insurance
Catastrophic Insurance & Program Expenses
Captive Layer
Self-Insured Layer
Capti
ve L
imit
$3
00,0
00
Sp
eci
fic
Sto
p L
oss
(e.g
., $
25,0
00
Unlim
ited
Per Claim
Frequency
Aggregate Stop Loss Group Stop Loss
ACA• Form 1094/1095• ER Notices/Disclosures• Variable Hour Tracking• Play or Pay• Minimum
Value/Essential Benefit• PCORI/Transitional
Reinsurance
ERISA• Form 5500• Discrimination Testing• Wrap Document • ER Notices/Disclosures
Technology
Tremendous Growth in Healthcare Segment• Pricing transparency• Ben Admin/Private
Exchange• Payroll/HRIS• Employer Reporting
Private Exchange
What is an exchange?
• Term appears in health care reform• Variation of ben admin platform• Could be more than one vendor/carrier• There are many types of exchanges!
– Public Marketplace (ACA – federal or state-based)– Employer sponsored private exchange– Individual private exchange
Private Exchange
Private exchange (potential benefits):• For Employers
- Packaged approach - Administrative
efficiency- Defined
Contribution
- For Employees- Select benefits
package that meets their needs
- Enrollment efficiency & simplicity
- Decision Support
TechnologyOne certainty in an uncertain market:• Tech = glue to broken system
– ER’s must automate processes• Payroll• Ben Admin• Reporting
• Which glue is the right glue?
Recap
• Healthcare landscape is shifting rapidly• Community rating driving self-funded migration• Carrier consolidation = America’s version of
“socialized healthcare”• Compliance becoming large burden for employers• Lines blurred for technology vendors and
solutions
Recommendations
• Review current technology (payroll, hris, ben admin)
• Who owns the compliance burden?• Review health insurance strategy
– Funding arrangement?– Best in breed or like everyone else?– Must have pro-active multi-year strategy
The Crichton Group3011 Armory Drive Suite 250Nashville, TN 37204
Austin MadisonVice President
P 615-687-2844
Questions?