ACA premiums to rise 25 percent in biggest jump yet
Zachary Tracer clarifies on ACA premiums rising yet again.
Originally posted on BenefitsPRO.com
Posted October 25, 2016
Premiums for mid-level Obamacare health plans sold on the federal exchanges will see their biggest jump yet next year, another speed bump in the administration’s push for enrollment in the final months of the U.S. president’s term.
Monthly premiums for benchmark silver-level plans are going up by an average of 25 percent in the 38 states using the federal HealthCare.gov website, the U.S. Department of Health and Human Services said in a report today. Last year, premiums for the second-lowest-cost silver plans went up by 7.5 percent on average across 37 states.
Individuals signing up for plans this year are facing not only rising premiums, but also fewer options to choose from after several big insurers pulled out from some of the markets created under the Affordable Care Act, known as Obamacare. While the ACA has brought uninsured numbers to record lows in the U.S., millions remain uninsured. To attract more people, the government has emphasized that subsidies are available for many people to help cushion the premium increases.
Protecting consumers
About 77 percent of current enrollees would still be able to find ACA plans for less than $100 a month, once subsidies are taken into account, according to the report. Subsidies are calculated based on the cost of the second-lowest-premium silver plan in a given area. Silver plans typically cover about 70 percent of an individual’s medical expenses, though additional subsidies can help make the coverage more generous for lower-income individuals.
“Even in places of high rate increases this year, consumers will be protected,” Kathryn Martin, assistant secretary for planning and evaluation at the health department, said on a conference call with reporters. Her message to consumers is to check if they are entitled to subsidies and shop for options: “The odds are good you’ll find plans more affordable than what the public debate about the ACA might lead you to expect.”
Changes in the cost of the benchmark silver plans varied widely among regions, and the median benchmark premium increase was 16 percent. Premiums actually declined about 3 percent in Indiana, to $229 a month. In Arizona, on the other hand, the benchmark premium more than doubled, from $196 a month to $422, the report shows.
The data released Monday confirm reports based on state regulatory filings that have been accumulating for months, showing much higher premiums for 2017. ACASignups.net, which tracks the health law, had also estimated a 25 percent rise in premiums on average, weighted by membership.
Silver plans are mid-level on Obamacare’s marketplaces, with other plans including bronze, gold and platinum.
The government data show that some people may be able to find lower-cost plans by switching from their current coverage. The U.S. said that if all people who currently have ACA plans switched into the cheapest option of the same “metal” level, they could cut their premiums by 20 percent. Some people will have to switch because their plan will no longer be offered.
See the original article Here.
Source:
Tracer, Z. (2016 October 25). ACA Premiums to rise 25 percent in biggest jump yet. [Web blog post]. Retrieved from address https://www.benefitspro.com/2016/10/25/aca-premiums-to-rise-25-percent-in-biggest-jump-ye?kw=ACA%20premiums%20to%20rise%2025%20percent%20in%20biggest%20jump%20yet&et=editorial&bu=BenefitsPRO&cn=20161025&src=EMC-Email_editorial&pt=News%20Alert
The demand for data transparency is mounting
Interesting thoughts on transparency data from Employee Benefit Adviser, by Suzy K. Johnson
December 2003 was a great time for health plans in America. This was when high deductible health plans and the underlying health savings accounts were enacted into law by the federal government.
With this law, we were provided the ability to engage employees more directly in the cost of their care with the elimination of copays and Rx cards under these plans.
What many brokers don’t realize is that the law allows anyone to fund the underlying health savings accounts. This means that employers can and should be shown how to use the savings in premiums created by moving to these types of plans to “fund” employees’ health savings accounts. This can result in a win/win for all.
When employers fund the employee’s HSA, they provide the employee the ability to direct additional money into a flex spending type of plan (HSA) that has much higher limits for funding, and allows the same expenses to be reimbursed along with long-term care premiums, COBRA premiums and Medicare Part B expenses. These accounts don’t have the “use it lose it” risk that flex medical reimbursement plans have always included.
A top priority
Now what we need is transparency data from the hospitals and providers. It is my belief that if every American was required to have a high deductible health plan paired with a health savings account only, the demand for transparency data would be palpable and the pressure forced on providers and hospitals to comply would amplify.
Right now the transparency data is not available and this needs to change. If the only plans employers could offer were HDHP plans with HSA accounts and if employers provided funding to help their employees to be able to afford the additional exposure shifted to them, the demand for transparency data would suddenly become top priority and the government would demand it of providers.
Yes, they are more complicated to understand, and yes, the programs require more employee education and hand holding. Nothing good happens when we sit on the sidelines. Let’s commit to becoming part of the solution!
See the original article Here.
Source:
Johnson, S. K. (2016 October 4). The demand for data transparency is mounting. [Web blog post]. Retrieved from address https://www.employeebenefitadviser.com/opinion/the-demand-for-data-transparency-is-mounting
Number Of Uninsured Falls Again In 2015
Interesting article from Kaiser Health News about decreasing uninsured rates by Julie Rovner
The federal health overhaul may still be experiencing implementation problems. But new federal data show it is achieving its main goal — to increase the number of Americans with health insurance coverage.
According to the annual report on health insurance coverage from the Census Bureau, the uninsured rate dropped to 9.1 percent, down from 10.4 percent in 2014. The number of Americans without insurance also dropped, to 29 million from 33 million the year before.
The Census numbers are considered the gold standard for tracking who has insurance and who does not, because its survey samples are so large. It does change methodology from time to time, however (most recently in 2013), so years-long comparisons are not necessarily accurate.
Still, between 2013 and 2015, the first two full years the health law was in effect, the uninsured rate dropped by more than 4 percentage points. The total number of uninsured fell by 12.8 million. Meanwhile, the percentage of Americans with insurance for at least some part of the year climbed to 90.9 percent, by far the highest in recent memory.
“I don’t remember it ever being in the 90s before,” said Paul Fronstin of the Employee Benefit Research Institute, who has been tracking insurance statistics since the early 1990s.
The Obama administration was quick to take credit for the insurance improvements. “The cumulative coverage gains since 2013 have put the uninsured rate at its lowest level ever,” said members of the White House Council of Economic Advisers in a statement.
The 2015 report shows insurance gains across all income levels, ages and types of employment, although some groups did better than others. Young adults — specifically 26-year-olds — remain the most likely to lack coverage. Although the Affordable Care Act guaranteed that young adults could stay on their parents’ plans longer than in the past, that protection ends when they turn 26.
Among states, those that took the health law’s option to expand the Medicaid program for the poor saw greater gains in coverage than those that did not. “The overall decrease in the uninsured rate of 2.4 percentage points in expansion states, compared with 2.1 percentage points in no-expansion states,” said the report. The state with the highest percentage of uninsured residents remained Texas at 17.1 percent; the state with the fewest uninsured remained Massachusetts with an uninsurance rate of 2.8 percent.
The single largest source of health insurance remains plans provided by employers. An estimated 177.5 million Americans had employment-based coverage in 2015, which was up more than 3 million from 2013.
See the original article Here.
Source:
Rovner, J. (2016 September 13). Number of uninsured falls again in 2015. [Web blog post]. Retrieved from address https://khn.org/news/number-of-uninsured-falls-again-in-2015/
2016 Draft Forms & Instructions Released: Affordable Care Act Reporting Update
Great feature from The National Law Review by Damian A. Myers,
Since our last ACA Reporting Update, the extended deadlines to distribute Forms 1095-B and 1095-C to covered individuals and employees and to file the forms with the IRS have passed. The IRS has stated, however, that late forms can still be submitted via electronic filing and the forms that received an error message should be corrected. By many accounts, the first ACA reporting season presented numerous challenges. From collecting large amounts of data to compiling the forms, to working with service providers that faced their own unique challenges, to facing form rejections and error notifications from an inadequate IRS electronic filing system, employers and coverage providers faced obstacles nearly every step of the way. Nevertheless, most employers and coverage providers were able to get the forms filed and put the 2015 ACA reporting season behind them.
But, alas, there is no rest for the weary. In late-July, the IRS released new draft 2016 Forms 1094-B and 1095-B (the “B-Series” Forms) and Forms 1094-C and 1095-C (the “C-Series” Forms). Additionally, on August 1, the IRS released draft instructions to the C-Series Forms (as of the date of this blog, draft instructions for the B-Series Forms have not been released). For the most part, the 2016 ACA reporting requirements are similar to the 2015 requirements, subject to various revisions described below.
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Various changes have been made to the forms and instructions to reflect that certain forms of transition relief are no longer applicable. For example, the non-calendar year transition relief (for plan years starting in 2014) that applied in 2015 does not apply in 2016. Similarly, changes have been made to reflect that the “Section 4980H Transition Relief” is still relevant only for non-calendar year plans though the end of the plan year ending in 2016. The Section 4980H Transition Relief exempts applicable large employers (“ALEs”) with 50-99 full-time employees from penalties under Section 4980H of the Internal Revenue Code (the “Code”) and reduces the 95% threshold to 70% for other ALEs. The relief also exempts ALEs from having to offer coverage to dependents if certain requirements are met. For calendar year plans, the threshold is at 95% throughout 2016 and dependent coverage must be offered during each month of the year.
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The draft instructions to the C-Series Forms provide more detail and examples on how ALEs should prepare the forms. Instead of referring to “employers” throughout the instructions, the IRS has replaced that term in most cases with “ALE Member.” The reason for this change is to highlight the fact that each separate ALE Member must file its own forms. Examples related to completing the authoritative Form 1094-C highlight that each separate entity (determined based on employer identification number) is required to file its own authoritative Form 1094-C.
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As promised by the IRS last year, there are two new indicator codes for Line 14 of Form 1095-C. These new codes ask employers to indicate whether a conditional offer was made to a spouse. An offer of coverage to a spouse is conditional if it is subject to one or more reasonable, objective conditions. For example, if a spouse must certify that he or she is not eligible for group health coverage through his or her employer, or is not eligible for Medicare, in order to receive an offer of coverage, the offer is considered conditional.
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The draft instructions to the C-Series Forms reflect that the good faith compliance standard applicable to 2015 forms (under which filers could avoid reporting penalties upon a showing of good faith) no longer applies for 2016 ACA reporting. Going forward, reporting penalties may be waived only upon the standard showing of reasonable cause.
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The draft instructions to the C-Series Forms include new information related to coding for COBRA continuation coverage. There has been some uncertainty regarding how to treat offers of COBRA continuation coverage since the IRS removed relevant guidance from its Frequently Asked Questions website in February 2016. Similar to the 2015 instructions, the draft 2016 instructions provide that offers of COBRA coverage after termination from employment should be coded with 1H (Line 14) and 2A (Line 16) whether or not the COBRA coverage is elected. The new instructions now state that this coding sequence also applies for other, non-COBRA post-employment coverage, such as retiree coverage, when the former employee was a full-time employee for at least one month of the year.
In the case of an offer of COBRA coverage following a reduction in hours, the basic coding requirement is the same as in 2015 – the offer of COBRA coverage is treated as an offer of coverage on Line 14 of the Form 1095-C. The draft instructions expand on this basic requirement to explain how to code Lines 14 and 16 when the offer of COBRA coverage is not made to a spouse or dependent. In general, for purposes of Code Section 4980H, an offer of coverage made once per year to an employee and his or her spouse and dependents is treated as an offer for each month of the year even if the coverage is declined for the employee, spouse, and/or dependents. Under general COBRA rules, only those individuals enrolled in coverage immediately prior to the qualifying event receive an offer of COBRA coverage.
So how does this play out when an employee with a spouse and dependents elects self-only coverage during open enrollment and later loses that coverage due to a reduction in hours? The draft instructions treat the initial offer of coverage at open enrollment and the offer of COBRA coverage as two separate offers of coverage. To determine the proper coding, the employer must look at who had the opportunity to enroll at each offer. During open enrollment, the employee, spouse and dependent had the opportunity to enroll. Thus, until the reduction in hours and loss of coverage, the coding should be 1E (offer to employee, spouse and dependent) in Line 14 and 2C (enrolled in coverage) in Line 15.
In contrast, the offer of COBRA coverage was only available to the employee and, therefore, after the reduction in hours, the coding should be 1B (offer to employee only) in Line 14. If the employee does not elect the COBRA coverage, code 2B (part-time employee) could be inserted in Line 16. If, however, the employee does elect COBRA coverage, it appears that code 2C (enrolled in coverage) should still be inserted in Line 16. Although this latter coding sequence is likely intended to protect the spouse and dependents from being “firewalled” from a premium credit, there appears to be nothing to indicate that the employer should not be assessed a penalty for failing to make an offer to the employee’s dependents.
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The draft instructions for the C-Series Forms provide additional insight into how to calculate the number of full-time employees for purposes of column (b) in Part III of the Form 1094-C. The draft instructions clarify that the determination of full-time employee status is based on rules under Code Section 4980H and related regulations and not on other criteria established by an employer. Note that, currently, the draft instructions state that the monthly measurement period must be used for this purpose, but it appears that this is a mistake and that it should reference both the monthly measurement and look-back measurement methods. The IRS may clarify this in the final instructions.
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One important non-change in the draft instructions is that the specialized coding for employees subject to the multiemployer plan interim guidance remains in effect for 2016 reporting. The interim guidance provides that an employee is treated as having received an offer of coverage if his or her employer is obligated pursuant to a collective bargaining agreement to contribute to a multiemployer plan on the employee’s behalf, provided that the multiemployer plan coverage is affordable and has minimum value and the plan offers dependent coverage to the eligible employee. The coding for such as employee is 1H (no offer of coverage) for Line 14 and 2E (multiemployer plan interim guidance) for Line 16.
There will undoubtedly be tweaks to the draft instructions to the C-Series forms, but significant changes appear unlikely. Given that only five months remain in 2016, employers should start planning now for 2016 ACA reporting based on the draft instructions and make alterations as necessary when final instructions and other guidance is released.
See the original article Here.
Source:
Myers, D. A. (2016 August 4). 2016 draft forms & instructions released: affordable care act reporting update. [Web blog post]. Retrieved from address https://www.natlawreview.com/article/2016-draft-forms-instructions-released-affordable-care-act-reporting-update
Small businesses wait for verdict on 2017 health care costs
Here's an informative article on healthcare costs, from San Francisco Chronicle (SFGate) by AP Business Writer Joyce M. Rosenberg
NEW YORK (AP) — Autumn is an anxious time for many small and medium-sized business owners as they wait to learn whether their health insurance costs will go up for 2017 — and if so, by how much?
"There's always a lump in your throat because you don't know what you're going to get," says Darren Ambler, a managing director at Insight Performance, a Dedham, Massachusetts-based human resources provider.
Whether a business sees a minuscule rise, a double-digit percentage increase or even a decline depends on factors including the state where the company is located and how much its insurance carrier paid in claims over the past year. If the average age of a company's employees rose or fell significantly — quite possible in a business with 10 or fewer employees — that could also affect the outcome.
Most of the increase in insurers' costs is a result of rising prescription drug prices, Ambler says.
While companies with 50 or more workers are required to offer affordable insurance to them and their dependents, many smaller businesses also do so because they believe it's right or they want to attract and retain good employees. When their carriers hike the premiums, companies have to decide whether to absorb the costs, scale back their coverage or find other alternatives.
Several medium-sized clients of The Megro Benefits Co., a consulting company, are facing 38 percent increases in their 2017 premium costs. Surges like that have owners thinking about what's called self-funding, says Cheryl Kiley, an adviser at Conshohocken, Pennsylvania-based Megro.
In self-funding, a business pays for all or part of employees' medical costs and hires an insurance company to administer its health plan. Companies typically purchase special policies to reimburse them in the event of employees' or dependents' catastrophic illnesses. Insurance companies charge less to administer self-funded plans because they don't have any risk, and employers also save because self-funded plans aren't subject to a 6.5 percent federal tax on premiums.
Although companies may be forced to find alternatives, Megro isn't seeing clients dropping insurance, president Bob Violasays.
"People won't come to work for them unless they have health insurance," he says.
RizePoint, which makes software for the food, lodging and retail industries and has about 75 employees, is paying 16 percent more for premiums on a policy that renewed Sept. 1. It's already considering self-funding for next year.
"It's a little bit risky," says Peter Johnson, a vice president at the Salt Lake City-based company. "But I don't want to see another 16 percent increase — it's nowhere near sustainable."
Johnson had budgeted for a rise of 12 percent. When RizePoint's carrier said premiums were going up more than that, Johnson searched unsuccessfully for a cheaper policy.
Rocky Finseth had the opposite experience. His premiums fell 11 percent although the policy was virtually unchanged from a year ago.
"I was surprised not only about the drop, but how large of a drop," says Finseth, owner of Carrara Nevada, a Las Vegas-based company that does lobbying on state and local issues in Nevada. His policy, which covers seven staffers, renews Oct. 1.
Finseth didn't question why his premiums dropped. He decided to use the savings to add vision coverage for his employees.
Some companies find that their policies have been discontinued.
"The plan we had was mysteriously canceled, and we were slotted into what we were told was the same plan, but when you looked at it, it was a worse plan," says Joseph Nagle, marketing director at EverCharge, a maker of electric vehicle charging stations. Among other things, the new plan had a higher deductible — $6,000 versus $5,000.
EverCharge, based in Emeryville, California, began researching other carriers and plans, chose three and asked its seven employees which they preferred. The company, which previously paid for all its staffers' insurance, gave them an option of continuing to have fully funded coverage, paying about $10 per month for better coverage, or $120 for another. They chose the middle option, and EverCharge was able to keep its health care costs unchanged, Nagle says.
Jason Anderson, owner of Datagame, a Kansas City, Missouri-based maker of software for online market research, hasn't received his renewal package yet. Anderson pays 100 percent of his three staffers' premiums, and 50 percent of their dependents' premiums.
He had a 5 percent increase for his 2016 premiums, an amount he doesn't see as significant. He says he can handle a 10 percent increase, but if he's facing a 20 percent hike, he might have to cut back on coverage for dependents.
"I keep waiting for the shoe to drop," says Anderson, who acknowledges that he'd be angry at an increase in the 20 percent range. "I don't see 10, 20, 30 percent improvements in what I am able to charge my clients," he says.
See the original article Here.
Source:
Rosenberg, J. M. (2016 September 14). Samll businesses wait for verdict on 2017 health care costs. [Web blog post]. Retrieved from address https://www.sfgate.com/news/us/article/Small-businesses-wait-for-verdict-on-2017-health-9222107.php
The Next Innovation In Controlling Healthcare Costs
As healthcare costs continually increase, understanding where the cost come from and how to manage them is critical. Bruce Barr gives a great editorial on why new trends are essential in controlling costs.
Original post from EmployeeBenefitAdviser.com on August 1, 2016.
Four decades ago, PPOs were hailed as the “silver bullet” to control healthcare costs. Participating providers were contractually obligated to accept discounted fees, which seemed like an obvious solution to out-of-control increases in healthcare costs. Self-funded plan sponsors readily adopted this approach to gain access to network discounts and lower their healthcare costs. In fact, some self-funded plan sponsors still periodically conduct a re-pricing analysis or another method of comparing which PPO yields the best discounts for their specific group.
However, as provider contacts expired, they were renegotiated at higher rates for providers and higher costs for plan sponsors. In addition, hospital charge-masters have increased at an exorbitant pace and have largely gone unregulated and uncontrolled. As a result, the significant discounts once achieved by PPOs no longer deliver the true savings that were seen in the 1980s and 1990s.
For example, a 60% discount on a $1,000 “oral cleansing device” (more commonly referred to as a toothbrush) clearly does not deliver value for the plan sponsor or member and is indicative of some of the billing practices that go undetected. The same could be said of a $150,000 knee replacement. Using a PPO for its discounted fees is somewhat analogous to buying a car by negotiating a discount off the list or sticker price.
As employers gain a better understanding of the questionable value of PPO discounts and pricing optics, reference based pricing (RBP) and reference based reimbursement (RBR) provide possible solutions by addressing the demand for:
· Price transparency,
· Benchmarking the cost of claims,
· Eliminating inappropriate charges, and
· A fiduciary or co-fiduciary serving on behalf of the plan sponsor.
With RBP, the plan specifies the amount that will be allowed for certain common procedures such as MRIs or knee replacements based on prevailing charges. Covered members have access to a list of participating providers who have agreed to accept these payments. Should the member choose a higher-priced provider, he or she may be responsible for the balance of the payment.
RBR uses a common “pricing reference” — often tied to the Medicare allowance and the actual cost for a specific service – and then reimburses the hospital or facility an additional 20-80%, allowing for the provider to make a “fair and reasonable” profit. For context, many PPO discounts result in net payments equal 250% or more of the Medicare allowance.
There are different ways this strategy can be implemented. Some employers begin using RBR exclusively for out-of-network claims. In other cases, RBR is used for all facility claims in conjunction with a PPO network for physician claims or an accountable care organization.
While used successfully by many employers, RBR can be disruptive for some employees when a provider attempts to “balance bill” patients for the difference between the set plan allowance and the provider’s billed charges. In the overwhelming majority of cases, however, these issues are quickly and easily resolved in favor of the plan sponsor and member. Rarely does a discrepancy like this lead to legal action.
Employers who decide to implement a RBR strategy need to carefully select a partner with expertise in communicating and educating employees about how these arrangements work and what to do should they receive a balance bill. The RBR partner should also have expertise in negotiating pricing discrepancies with providers, providing employee advocacy, indemnifying the plan and its members, and modifying the language in the plan document.
Many early adopters of this approach were often those who were subject to extreme increases in healthcare costs and who saw RBP and RBR as a last ditch effort that would enable them to continue to provide medical benefits for their employees. We’re now beginning to see more employers adopt this approach as a way to more effectively determine and control the cost of healthcare.
See Original Post Here.
Source:
Barr, B.F., (2016, August 1). The next innovation in controlling healthcare costs [Web log post]. Retrieved from https://www.employeebenefitadviser.com/opinion/the-next-innovation-in-controlling-healthcare-costs
Office Chatter: Your Doctor Will See You In This Telemedicine Kiosk
Original Post from KHN.org
By: Phil Galewitz
On the day abdominal pain and nausea struck Jessica Christianson at the office, she discovered how far telemedicine has come.
Rushing to a large kiosk in the lobby of the Palm Beach County School District’s administrative building where she works, Christianson, 29, consulted a nurse practitioner in Miami via two-way video. The nurse examined her remotely, using a stethoscope and other instruments connected to the computer station. Then, she recommended Christianson seek an ultrasound elsewhere to check for a possible liver problem stemming from an intestinal infection.
The cost: $15. She might have paid $50 at an urgent care center.
The ultrasound Christianson got later that day confirmed the nurse practitioner’s diagnosis.
“Without the kiosk I probably would have waited to get care and that could have made things worse,” she said.
Endorsements like Christianson’s demonstrate how technology and positive consumer experiences are lending momentum to telemedicine’s adoption in the workplace.
Less than a decade ago, telemedicine was mainly used by hospitals and clinics for secure doctor-to-doctor consultations. But today, telemedicine has become a more common method for patients to receive routine care at home or wherever they are — often on their cellphones or personal computers.
In the past several years, a growing number of employers have provided insurance coverage for telemedicine services enabling employees to connect with a doctor by phone using both voice and video. One limitation of such phone-based services is physicians cannot always obtain basic vital signs such as blood pressure and heart rate.
That’s where telemedicine kiosks offer an advantage. Hundreds of employers — often supported by their health insurers — now have them installed in the workplaces, according to consultants and two telemedicine companies that make kiosks, American Well and Computerized Screening, Inc.
Employers and insurers see the kiosks as a pathway to delivering quality care, reducing lost productivity due to time spent traveling and waiting for care, and saving money by avoiding costlier visits to emergency rooms and urgent care facilities.
Jet Blue Airways is adding a kiosk later this year for its employees at John F. Kennedy International Airport in New York. Other big employers providing kiosks in the workplace include the city of Kansas City, Missouri.
Large health insurers such as Anthem and UnitedHealthcare are promoting telemedicine’s next wave by testing the kiosks at worksites where they have contracts.
Anthem has installed 34 kiosks at 20 employers in the past 18 months. John Jesser, an Anthem vice president, said kiosks are a good option for employers too small or disinclined to invest hundreds of thousands of dollars in creating an on-site clinic with doctors and nurses on standby.
“This technology should make it more affordable for employers of many sizes,” Jesser said.
Kiosks are typically used for the same maladies that lead people to see a doctor or seek urgent care — colds, sore throats, upper respiratory problems, earaches and pink eye. Telemedicine doctors or nurse practitioners can email prescriptions to clients’ local pharmacies. Employees often pay either nothing or no more than $15 per session, far less than they would pay with insurance at a doctor’s office, an urgent care clinic or an emergency room.
Despite kiosks’ growing use in telemedicine, it’s unclear whether they will be supplanted as smartphones, personal computers and tablets enable people to access health care anywhere with a Wi-Fi connection or cell service. Some employers already offer kiosk and personal device options, including MBS Textbook Exchange in Columbia, Missouri, which has 1,000 workers.
Workplace kiosks’ appeal is they are quiet, private spaces to seek care. Consumers can get their ailments diagnosed remotely because the kiosks are equipped with familiar doctors’ office instruments such as blood pressure cuffs, thermometers, pulse oximeters and other tools that peer into eyes, ears and mouths. The instrument readings, pictures and sounds are seen and heard immediately by a doctor or nurse practitioner.
“The kiosk gives the doctor more tools to diagnose a wider range of conditions,” Anthem’s Jesser said.
The downside is that the machines cost $15,000 to $60,000 apiece, which may still be too much for some employers.
“Telemedicine kiosks look promising and may still take off, but I don’t see explosive growth,” said Victor Camlek, principal analyst with Frost & Sullivan, a research firm.
Employers’ experiences are mixed.
Officials in Kansas City, Missouri, estimate the kiosk placed in city hall almost a year ago has saved the local government at least $28,000. That’s what Kansas City hasn’t spent because employees and dependents chose the telemedicine option instead of an in-person doctor visit. The city also estimates it has gained hundreds of productive work hours — that’s the time employees saved by not leaving work to see a doctor.
In contrast, fewer than 175 of the 2,000 employees at the Palm Beach County School District headquarters have used the kiosk there in its first year, said Dianne Howard, director of risk management.
Howard remains hopeful: “This is the future of health care.”
The district’s kiosk was supplied at no cost by UnitedHealthcare, as part of a test also involving two other employers in Florida.
Those kiosks connect employees to nurse practitioners at Nicklaus Children’s Hospital in Miami. The hospital employs an attendant at each kiosk location to help workers register and use some of the instruments, such as the stethoscope.
Other telemedicine kiosks, such as those made by America Well, are designed to be totally self-service for employees. They also offer users immediate access to a health care provider. American Well has deployed about 200 kiosks and is in midst of rolling out 500 more, mostly to employers, the company said. It also places kiosks in retail outlets and hospitals.
Telemedicine’s increasing sophistication is winning over some traditional-minded physicians.
The WEA Trust in Madison, Wisconsin, a nonprofit that offers health coverage to public employers, installed a kiosk for the benefit of its 250 workers last fall.
Dr. Tim Bartholow, a family doctor by training and chief medical officer for the trust, said he was cautious about physicians treating patients they haven’t seen in person. After observing employees using it, Bartholow is convinced it can help them get good care.
“I don’t think telemedicine is making a doctor being on site quite agnostic, but it is certainly reducing the premium on being in the same space as the patient,” Bartholow said.
Insurers declare they are moving carefully, too, recognizing that telemedicine has its limits and they must depend on practitioners to tell patients when they have to see a doctor — in person.
“We have to rely on their experience and judgment,” Jesser said.
Health Care Consumerism Is More Than A Benefit Design
Original Post from BeneftisPro.com
By: Steven Auerbach
The shift to health care consumerism is well underway. Trends continue to point to increased financial responsibility for consumers with rising deductibles, increased consumer out-of-pocket responsibilities, and accelerated adoption of consumer-directed health care plans (CDHPs), health savings accounts (HSAs), and other account-based benefit offerings.
According to Mercer, enrollment in CDHPs among large employers nearly doubled in the past three years from 15 percent to 28 percent of covered employees.
Employer adoption of these consumer-directed benefit designs will continue to grow for the foreseeable future, driven by the need for cost control, the impact of health care reform and the looming excise tax. The costs of providing health care continue to rise, surpassing $25,000 for an average family for the first time in 2016 (Milliman Medical Index).
However, the fact that the term “consumer-directed health care (CDH)” has become almost synonymous with CDHPs and HSAs is a bit of a misnomer. In reality, CDH is much more than a benefit design – it is a paradigm shift for how consumers must manage their health care and make health care decisions going forward.
Dimensions of consumer-directed health care
The underlying premise of CDH is that, if given more financial responsibility for health care and empowered to make informed decisions, consumers will make better choices – leading to improved health outcomes and decreased overall health care costs. Implicit in this definition are two equally important dimensions:
- Benefit designs that require increased consumer financial accountability
- Empowerment and engagement to support decision-making
The market has made considerable progress shifting to benefit models that increase consumer financial responsibility, as evidenced by the data above. While new plan designs have been created and successfully implemented, financial accountability is only the beginning— behavior must change too, not just costs. We have only just begun to unlock the second dimension of health care consumerism.
Giving somebody new responsibility without the education, tools and support to manage those responsibilities is like giving a teenager the keys to the car without teaching them to drive.
Unlocking consumer engagement
So where does the health care industry really stand in terms of engaging and empowering consumers to make better choices? The health care industry is still struggling to drive meaningful consumer engagement.
Consumer fluency is low. Alegeus research is clear that consumers still don’t have a good grasp on how the plans work, how to predict and manage out of pocket costs, how to determine coverage, etc. Engagement overall is low. The average consumer interacts with their health plan just one or two times per year – and more than 40 percent of members have never taken the time to log-on, dial-in, subscribe, or download any content from their benefit providers.
And in many cases, consumers are resistant to change. When asked whether they wanted to take a more active role in managing their health care, 50 percent said no thanks.
Employers are now spending nearly $700 per employee on various employee engagement programs related to health care, per Fidelity. There are more tools and resources than ever before. Yet most of these programs are delivered with a “one-size-fits-all” approach, and the consumer experience is still very fragmented.
However, by its very nature, CDH may be the key to unlocking consumer engagement. CDHP members are significantly more engaged than their counterparts in traditional coverage for one very important reason…
People pay attention to their money
According to our research, people enrolled in CDHPs scored universally higher on all measures of engagement. CDHP members:
- Are considerably more fluent in the details of health care coverage, costs and billing
- Are more value-conscious - 50 percent more likely to research and compare costs for health care purchases
- Interact more frequently– the average CDHP member interacts with their account 10-50 times per year
- Leverage available resources & channels - one-third more likely to consume content and engage with their benefit service providers through available channels
- Are more likely to participate - twice as likely to participate in employer engagement and wellness programs
Although CDHP members interact more frequently, the key to true engagement and behavior change is not just driving more interactions, it is driving strategic engagement that is targeted, timely and relevant.
Health & wealth must converge
The path to true, meaningful engagement in health care may lie in the convergence of these financial components with the traditional health care domain. No matter what age, health status, or consumer segment, the responsibility for managing finances and costs will become universal.
The convergence of claims, financial transactions and other behavioral and demographic data will provide a robust foundation for targeted engagement.
The fact that consumers pay closer attention to their finances presents a unique opportunity to tap into a captive audience with personalized offers, messages and value-added tools designed to improve engagement, influence behavior and enhance decision-making.
For the vision of consumer-directed health care to be fully realized, it is imperative that employers and benefit providers do not overlook the critical importance of education and targeted engagement to empower better decision making – and better outcomes for all stakeholders.
Core Benefits Drive Satisfaction More Than Niche Offerings
Original Post from SHRM.org
By: Stephen Miller
Improving traditional core benefits could be the best way to increase employees’ satisfaction with their rewards mix, new research suggests.
The three offerings with the greatest effect on how employees rate their benefits are health insurance, 401(k) retirement plans and vacation/paid time off. Among these, health insurance was by far the biggest driver of employee satisfaction, according to a new study, Which Benefits Drive Employee Satisfaction?, from Glassdoor Economic Research, the research arm of career website Glassdoor.
At organizations where employee ratings of the employer-provided health coverage increased by 1 star (out of 5), there was also a statistically significant increase in average employee satisfaction with the overall benefits package. (See graph above, from Glassdoor Economic Research. *Denotes that the increase in the overall benefits rating was statistically significant.)
Notably, 4 in 5 U.S. workers report they prefer new benefits or perks to a pay raise. This finding supports a recent Glassdoor survey that found health insurance, paid time off and 401(k) plans are among the top benefits employees would prefer over a pay increase.
Benefits with Narrower Appeal
Two benefits that did not seem to have a significant impact on overall employee satisfaction were maternity/paternity leave and employee discounts.
“Though many employers have added generous maternity/paternity leave plans, it is possible benefits that are not used by a large subset of employees do not impact overall benefits package satisfaction,” the researchers suggested.
“We know benefits and perks are an important recruiting tool in today’s challenging hiring landscape, and this study shows that the flashiest or trendy benefits aren’t always better,” said Andrew Chamberlain, chief economist of Glassdoor. “Investing in core benefits programs like health care coverage, retirement plans and paid time off will go far with new and current employees. Other benefits, like maternity/paternity leave, are important to recruit and retain smaller subsets of employees—like new parents—though we saw little impact on overall satisfaction related to benefits that don’t touch a wide variety of employees.”
He advised, “Employers who have well-rounded compensation plans that include core benefits, fair and competitive pay, and desirable perks stand to attract and retain top talent.”
A separate Glassdoor Economic Research study, The Best Industries for Benefits, found that the best benefits packages, according to employees, are found in the finance and technology industries.
Stephen Miller, CEBS, is an online editor/manager for SHRM. Follow him on Twitter @SHRMsmiller.
Many Patients Don't Get Much Out of EHRs
Original post benefitspro.com
Most Americans appear to view electronic health records (EHR) as a welcome convenience, but not as a game-changing medical advance. That’s what one can glean from a recent survey of patients conducted by HealthMine.
The poll of 500 insured adults found that 60 percent have access to an electronic health record, but only 22 percent of those with an EHR say they use it to guide their medical decisions. The great majority of patients say they rely on the technology as a way to “stay informed.”
Other results:
- 71 percent of those with EHRs say they access the records when needed
- 15 percent say it’s hard to understand the information presented
- 14 percent never access their EHR
Of course, not all EHRs are created equal. Some patients report only having access to a limited amount of information, and others say they are not able to see that same information as their doctor:
- 69 percent can see lab work/blood tests
- 60 percent see their prescriptions
- 55 percent view their billing information
- 47 percent see notes from their physician
Bryce Williams, CEO of HealthMine, suggested that many patients have not yet fully grasped the value of EHRs. Educating people on how to benefit from them could be an important part of wellness programs, he said.
"Electronic health records are still in the early phases of consumer adoption. They have the potential to engage consumers more directly in managing their health," he said. "Wellness programs can help bridge the gap between EHR adoption and understanding by making the information both meaningful and actionable for patients."