seminar presentation - lynnwood - capital benefit...this presentation is intended solely as a...
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Delivering the leading transparency platform to health plans for over 8 years.
Offers configurable healthcare shopping experiences for health plans & employers
Enables making smarter choices around choosing providers and treatments based on cost, quality, convenience, and social
Serving over 65 Health Plans and their employer clients that cover 100+ million members
is a portfolio company of
Cambia Health Solutions
Employer Solutions 30
Affordable care options exist todayShoulder arthroscopy
In Dallas
$3,000to
$26,000
In Dallas
$3,000to
$26,000
In Seattle
$2,000 to
$18,000
In Seattle
$2,000 to
$18,000
In Boston
$4,000 to
$22,000
In Boston
$4,000 to
$22,000
32Employer Solutions
web-based tools
But where can we go for answers?
34Employer Solutions
wellness initiatives
health assessment
DM programs
GENERIC PHOTO
NO PRICES AVAILABLEDON’T KNOW IF IT’S IN STOCK
YOU CAN’T
BUY THIS HERE.
CALL 555-5555
NOTHING TO SEE HEREWE DON’T HAVE ANY SUGGESTIONS
39Employer Solutions
Compare options from a detailed level
Provider A
Provider B
Provider C
Provider D
40Employer Solutions
Our shopping tools are informing decisions…
Gallbladder Removal
Inpatient Outpatient Surgical
$19,102 $11,107 $6,360
Cost Estimator users choose
Non-users choose
Average Cost
Least expensiveMost expensive
41% 55%
10% 70% 20%
4%
(2 year period of regional health plan’s claims history)
Inpatient Outpatient Surgical
$19,102 $11,107 $6,360Average Cost
Least expensiveMost expensive
$10,319Average Cost for Cost Estimator users
$14,195Average Cost for Non-users
Gallbladder Removal
(2 year period of regional health plan’s claims history)
41Employer Solutions
Informed decisions drive cost savings
43Employer Solutions
How can we engage consumers?
Proactive campaigns
Foundational work
Conveniences
Opportunity analysis
Targeted promotions
Concierge line
Microsite access
Personalized alerts
Telehealth
Our integrated solution
Employer Solutions 44
Employer customized buy-up (250+ ee)
Powered by HealthSparq
On Regence.comtoday (all members)
Powered by HealthSparq
Transparency tools that enable smarter decisions
• Single Search• Real Prices• Patient Ratings and
Reviews• Health and Wellness
Community
Customized strategy to truly engage employees
• Analysis and Engagement Services
• Additional ways to access information
• Proactive Campaigns• Conveniences
Affordable Care Act Implementation Update
Presentation to Master Builder’s AssociationSeptember 30, 2014
Chris Bandoli
Director, Government Affairs
Regence BlueShield
© 2014 Regence BlueShield44
Disclaimer
This presentation is intended solely as a general overview of the subjects discussed. It is not an exhaustive review of federal or state requirements, and nothing in this presentation should be considered to be or relied upon as legal or financial advice
The materials and discussion represent the presenter’s understanding of current federal and state requirements, which are subject to change at any time and may be subject to differing interpretations
While the information provided is believed to be accurate, it should not be relied upon as a substitute for independent research and consultation with legal and other experts
45 © 2014 Regence BlueShield
How it was supposed to work in 2014
Expanded CoverageIndividual Insurance
• Guaranteed Issue
• Coverage Mandate
• Tax Credits & Subsidies
• Exchanges for competition
Employer Coverage• Penalties for not
offering coverage
• Small Employer
Tax Credit
Medicaid ExpansionEveryone up to 133% FPL
46 © 2014 Regence BlueShield
2014 - Medicaid
June 2012: U.S. Supreme Court ruled states can’t be forced to expand Medicaid by threat to withhold all Medicaid funds
Washington expanded Medicaid in 2013 legislative session
Enrollment: Approximately 300,000 newly eligible adults
© 2014. Regence BlueShield of Idaho, all rights reserved. 47 © 2014 Regence BlueShield
2014 – Individuals & Small Employers
“You can can’t might be able to keep your current plan.”• Administration announced in late 2013 that, at the discretion of the states,
renewals of non-ACA compliant plans will be permitted through Oct. 1, 2016 for individuals and small employers
• Washington said “no”
• Commissioner Kreidler anticipated around 290,000 cancellations at the end of 2013
• Still a possibility of offering extension to 51-99 size groups in 2016, pending OIC decision…
© 2014. Regence BlueShield of Idaho, all rights reserved. 48
X X
© 2014 Regence BlueShield
2014 – Individuals
No changes to penalty provisions
Need to be aware of open enrollment period and special enrollment opportunities
Open enrollment for 2015 will run November 15, 2014 to February 15, 2015
© 2013. Regence BlueShield of Idaho, all rights reserved..49 © 2014 Regence BlueShield
2014 - Exchanges
Washington Health Benefit Exchange – “Healthplanfinder” – among most successful state exchanges in the nation
Enrollment: Approximately 170,000
Issues
• Initial/special enrollment
• “Aggregating” premiums
Budget
• HBE wants $19 million increase in 2015
• Additional dollars would be funded by assessment on plans sold in Exchange
© 2014. Regence BlueShield of Idaho, all rights reserved. 50 © 2014 Regence BlueShield
2014 – Large Employers
July 2, 2013: Treasury announces no employer penalties for 2014
February 10, 2014: Treasury releases final employer shared responsibility rule and fact sheet announcing more “transitional relief”
• Employers with less than 100 employees get additional year delay
• Employers with 100+ get some relief as well
Treasury Fact Sheet: http://www.treasury.gov/press-center/press-
releases/Documents/Fact%20Sheet%20021014.pdf
On July 24, 2014 the Internal Revenue Service released drafts of the forms that individuals, insurers, and employers will use for reporting information to the IRS necessary for reconciliation of premium tax credits and for the enforcement of the individual and employer mandate programs
© 2014. Regence BlueShield of Idaho, all rights reserved. 51 © 2014 Regence BlueShield
2014 in summary . . .
Expanded CoverageIndividual Insurance
• Guaranteed Issue
• Coverage Mandate
• Tax Credits &
Subsidies
• Exchanges for
competition
Employer Coverage• Penalties for not
offering coverage
• Small Employer
Tax Credit
Medicaid ExpansionEveryone up to 133% FPL
© 2014. Regence BlueShield of Idaho, all rights reserved. 52 © 2014 Regence BlueShield
Looking Ahead: Employers must know FTEs
53
Number of Full Time Employees working 30+ hours per week for the month
(or at least 130 Hours during the Month)
Full Time Equivalents: Add all hours in the month for part-time employees, then divide by 120 hours
+ = FTEs for the Month
ThenTotal all FTEs for all months for the year and divide
by 12 to get average FTE per month = <50 = Small50-99 = Mid
100+ = Large
Note: Employers may be able to use six months rather than full year for initial FTE determination
© 2014 Regence BlueShield
2015: Mid-Sized Employers (51-99 FTEs)
Employer penalty will not apply until 2016
• Employer must certify it meets eligibility requirements on form prescribed by Treasury
Required to provide coverage to at least 95% of full-time employees in 2016 or pay a shared responsibility penalty
Non-calendar year plans have until renewal in 2016 to come into compliance
Look-back measurement period will be in 2015
© 2014. Regence BlueShield of Idaho, all rights reserved. 54 © 2014 Regence BlueShield
2015: Large Employers (100 or more FTEs)
Employer penalty will apply in 2015
Non-calendar year plans can wait until 2015 renewal to come into compliance
Required to provide coverage to at least 70% of full-time employees for 2015 and 95% of full-time employees for 2016
Dependent Coverage requirement will not apply in 2015 to large employers that are taking steps to arrange for dependent coverage in 2016
Look-back Measurement Period in 2014 (6 months OK)
© 2014. Regence BlueShield of Idaho, all rights reserved. 55 © 2014 Regence BlueShield
Association Health Plans
ACA regulations mandate that association plans be “bona fide”
• Bona fide = certain ERISA and HIPAA standards
OIC enforcing “bona fide” standards upon renewal of the association master contract in 2014
• Regence Non-Bona Fide AHPs: NET, EST, WBACC
• Regence Bona Fide AHPs: MBA/BIAW, NMTA, WTIA, WFB, Vigilant, WAIA
© 2013. Regence BlueShield of Idaho, all rights reserved. Private and confidential.56 © 2014 Regence BlueShield
2014 State Legislative & Regulatory Action
Regulatory
• Network Access rules
• Mental Health rules
• Filing standardization rules
• Transgender exclusions ban
Legislative
• Innovation Plan
• Grace Periods
• Prior Authorization
© 2013. Regence BlueShield of Idaho, all rights reserved. Private and confidential.57 © 2014 Regence BlueShield
Regence MedAdvantage
What is an Employer Group Waiver Plan (EGWP) Program?
An exclusive group Medicare option available to retired employees of members of the Master Builders
Access to enhanced benefits
More flexible enrollment times than traditional Medicare timeframes
Regence MedAdvantageRegence Medicare Group Retiree Plans
Medicare Group Retiree Plans are health plans offered through Centers for Medicare & Medicaid Services (CMS) and administered by Regence.
Easy to administer, they help minimize your exposure and accounting obligations for your retired employees and protect your business against cost fluctuations, providing a fully insured solution that ensures less disruption and greater satisfaction for your retirees.
Regence MedAdvantage
Potential for lower costs
Medicare Group Retiree Plans offer lower-cost coverage that can result in lower contributions for retirees.
You can typically pay lower rates with a group retiree plan. Plus, they give you improved predictability of costs without significantly increasing retiree contributions.
Regence MedAdvantage PPO plan
Freedom to use your own doctor and hospital
No referrals to see specialists
Large provider and pharmacy network
Lowest cost sharing in-network
Still covered out-of-network with slightly higher cost sharing, depending on your plan choice
Worldwide Coverage including Worldwide Emergency Coverage
Nurse Advice Line – 24 hours a day
Round the clock answers from a registered nurse
Call anytime, from anywhere
Case and Condition Management
Nurse case management support for serious illness or catastrophic injury
Disease management for help managing chronic conditions
SilverSneakers®
• Tools to achieve your health and fitness goals
• Access to over 245 fitness locations
• Use fitness equipment, pools and saunas*
• Take SilverSneakers classes*
Find your nearest location at:www.silversneakers.com
*Amenities vary by location
Pharmacy Network*Large national network
Local and national pharmacies
Costco, Fred Meyer, Walgreens, Rite-Aid, Safeway, Wal-Mart and more!
Fill prescriptions while traveling at any network pharmacy
Convenient mail-order options and 90 day retain pharmacy options save you time and money
* United States and territories only
EligibilityRetiree Members and their spouses1. Must be entitled to Medicare benefits under Part A and
enrolled in Part B
2. Must be retired, not active
3. Can live anywhere in U.S., not in territories
4. Medicare-eligible spouse of an active employee is eligible too!
5. Cannot live outside of the U.S. for more than 12 months at a time
Regence VitalityImproving Employee Health and Productivity
81Regence BlueShield serves select counties in the state of Washingtonand is an Independent Licensee of the Blue Cross and Blue Shield Association
Michael Cochran, Director of WellnessRegence BlueShield
Presentation Objectives
The Health & Wellness Opportunity
Business Imperative for Health
Our Focus and Objectives
Regence’s Integrated Solution
Next-Gen Wellness Solution
© 2014 Regence BlueShield82
Health Care Premiums Outpace Worker’s Earnings and Inflation
© 2014 Regence BlueShield85
131%
191%
72%
127%
212%
17%
38%54%
13%28%
43%
0%
50%
100%
150%
200%
250%
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Health Insurance PremiumsWorkers' Contribution to PremiumsWorkers' EarningsOverall Inflation
SOURCE: Kaiser/HRET Survey of Employer‐Sponsored Health Benefits, 1999‐2014. Bureau of Labor Statistics, Consumer Price Index, U.S. City Average of Annual Inflation (April to April), 1999‐2014; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey, 1999‐2014 (April to April).
Economic Rational for Worksite Health
© 2014 Regence BlueShield86
Source: Goetzel, JOEM, (2004) data adjusted to 2010 by Mercer Employer Survey Results and by Collins Presenteeism study (2005) of Dow Chemical that was used for determining the Presenteeism cost.
Health & Wellness: The Business Imperative
Health is a total business issue which affects financial performance• Companies with “highly effective” worksite programs are 40% more
likely to report financial performance above their peers
Employers understand the value of health and well-being programs to their overall organizational health strategy • Seventy percent of companies are developing a workplace culture
where employees are responsible for their health, and understand its importance as a top priority of their health and productivity program
2013/14 Staying@Work Report; TowersWatson/National Business Group on Health
© 2014 Regence BlueShield87
For employers to remain financially competitive, it is imperative they effectively manage rising health care costs
© 2014 Regence BlueShield88
1% 4% 2% 4% 4%9%
14% 15%20% 24%
24%21%
29%26%
27%
32%
41% 32%33%
37%
35%
20% 22% 17%8%
0%
20%
40%
60%
80%
100%
Wellness Programs Consumer‐DrivenHealth Plans
(Ex: High‐DeductiblePlan Combined with aHealth Savings Account)
Disease ManagementPrograms
Higher Employee CostSharing
Tighter Managed CareRestrictions
Don’t Know Not At All Effective Not Too Effective Somewhat Effective Very Effective
SOURCE: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2013
Effectiveness of Strategies to Contain Health Costs
Worksite Programs: Components for Success
Culture of Health
Leadership
Strategy
Engagement Communications
Role Models
Evaluation
© 2014 Regence BlueShield89
Regence Wellness: Our Focus
Our Focus:Maximize employee health and productivity
Our Objectives:
© 2014 Regence BlueShield90
• Provide personalized solutions that meet employees where they are at• Leverage innovative technologies to drive engagement• Utilize the latest in behavioral economics theory and incentive plan design
Increase Engagement
• Establish a “Culture of Health” within the workplace• Provide tools and resources to enable employees to achieve optimal health• Integrate with Regence Care Management programs and other assets
Improve Health
• Focus on Value on Investment (VOI)• Measure the impact on both health and productivity• Move employees from higher risk to lower risk
Bend the Cost Curve
Regence Vitality: A Solution & Differentiator
© 2014 Regence BlueShield91
Not just another product but a solution to improve the health and productivity of your workforce
AnalyticsOur analytic solutions provide you with actionable recommendations,
targeted interventions, and the means to measure outcomes
The Power of RegenceIntegration with the Regence portfolio provides innovative
solutions that can be tailored to meet the needs of your company
ConsultingOur consultants help develop your
strategy, provide fresh ideas to maintain your program, and
establish measures of success
Health CoachingOur health coaches provide your employees with the guidance and
tools necessary to produce measurable behavior change
Solutions to create a “Culture
of Health”
Comprehensive Online Wellness Dashboard
© 2014 Regence BlueShield92
Personalized list of online programs
Rewards tracker with summary of activities
Health Coach only available to Vitality members
One Click to GHA
Next-Gen Wellness: An Integrated Solution
© 2014 Regence BlueShield94
Web Platform (table stakes)
“Boots On the
Ground” (differentiator)
Next-Gen Wellness
Web Platform for WellnessComprehensive on-line wellness capabilities
Integrated with Regence.com
Flexible incentive and challenge platforms
“Boots on the Ground”Dedicated Wellness Consultants
Regence-employed Health Coaches
Event support (health fairs, webinars)
Communications support
Robust reporting
Next-Generation WellnessA comprehensive health and productivity solution
Distinct wellness packages