Nearly One in Four Employers Say Private Health Insurance Exchanges Could Provide a Viable Alternative for Full-Time Active Employees in 2016

Originally posted September 25, 2014 on

ARLINGTON, Va.--(BUSINESS WIRE)--Results of a July 2014 survey of midsize to large employers by global professional services company Towers Watson (NYSE, NASDAQ:TW) showed that 28% said they had already extensively evaluated the viability of private exchanges. Nearly one in four (24%) said private exchanges could provide a viable alternative for their active full-time employees as soon as 2016.

“Private exchanges are a relatively new path for many employers — one that has only recently become available to provide benefits for active employees”

The results are from the 2014 Towers Watson Health Care Changes Ahead Survey, which was completed by 379 employee benefit professionals from a variety of industries and reflect health care benefit decisions for 2016 – 2017.

The survey also revealed that the top three factors that would cause employers to adopt a private exchange for full-time active employees are:

Evidence they can deliver greater value than their current self-managed model (64%)

Adoption of private exchanges by other large companies in their industry (34%)

An inability to stay below the excise tax ceiling as 2018 approaches (26%)

Public Exchanges Not Considered Viable for Full-Time Active Employees

In contrast, nearly all employers surveyed (99.5%) said they have no plan to exit health benefits for active employees and direct them and their families to public exchanges, with or without a financial subsidy. More than three out of four employers (77%) said they are not at all confident public exchanges will provide a viable alternative for their active full-time employees in 2015 or 2016.

“Private exchanges are a relatively new path for many employers — one that has only recently become available to provide benefits for active employees,” said Dave Osterndorf, a managing director with Towers Watson’s OneExchange. “However, with the Patient Protection and Affordable Care Act’s excise tax top of mind for large employers, and with the potential to cost companies billions of dollars unless they act now to keep the cost of health benefits below government-mandated thresholds in 2018 and beyond, new solutions are necessary. Even employers that have managed to keep increases in their health care benefit costs lower than industry averages are working very hard to maintain that success. Private exchanges offer employers a new opportunity to save on health care coverage with a reduced operational burden, which is the main reason they are more seriously evaluating them for their active employees.”

Data from the 2014 Towers Watson Health Care Changes Ahead Survey revealed that nearly three-quarters (73%) of employers said they are somewhat or very concerned they will trigger the excise tax based on their current plans and cost trajectory. More than four in 10 (43%) said avoiding the excise tax is the top priority for their health care strategies in 2015.

Osterndorf added, “Effective private exchanges can provide value in many ways. For example, as more employers move to account-based health plans, they can realize the promise of avoiding the excise tax while providing the added benefit of putting employees in charge of how their health care dollars are spent. Private exchanges offer more choice, including account-based plans, with the tools and support for helping employees make better health decisions, and recognize the connection between their physical and financial well-being. Employee understanding and engagement are critical to the long-term sustainability of an employer’s program. Private exchanges can accelerate the fulfillment of that goal.”

According to the 19th Annual Towers Watson National Business Group on Health Employer Survey on Purchasing Value in Health Care, released in March 2014, nearly three-quarters of respondents currently offer account-based health plans (ABHPs), with another 9% expecting to add one for the first time in 2015. Nearly 16% of respondents have adopted ABHPs as their only plan option, up from only 7% in 2012. Nearly one-third of all companies could offer ABHPs as their only option by 2015, if they follow through with current plans.

About the Surveys

The 2014 Towers Watson Health Care Changes Ahead Survey offers insights into the focus and timing of U.S. employers’ plans and perspectives related to their health benefits, and their efforts to better manage costs and employee engagement, as well as their planned responses to the business risks associated with the 2018 excise tax. The survey was completed during July 2014 by 379 employee benefit professionals from midsize to large companies across a variety of industries and reflects respondents’ 2014 – 2017 health care benefit decisions. The responding companies comprise a broad range of industries and business sizes, and collectively employ 8.7 million employees.

The 19th Annual Towers Watson/National Business Group on Health Employer Survey on Purchasing Value in Health Care tracks employers’ strategies and practices, and the results of their efforts to provide and manage health benefits for their workforce. This report identifies the actions of high-performing companies, as well as current trends in the health care benefit programs of U.S. employers with at least 1,000 employees. The survey was completed by 595 employers between November 2013 and January 2014. Respondents collectively employ 11.3 million full-time employees, have 7.8 million employees enrolled in their health care programs and represent all major industry sectors.


Towers Watson (NYSE, NASDAQ: TW) is a leading global professional services company that helps organizations improve performance through effective people, risk and financial management. The company offers consulting, technology and solutions in the areas of benefits, talent management, rewards, and risk and capital management. Towers Watson has more than 14,000 associates around the world and is located on the web at

What are the 4 types of private exchanges?

Originally posted September 16, 2014 by Brian M. Kalish on

Private exchanges are an ever-popular option for employers to provide health insurance to both their active and retiree populations. Estimates put the number of private exchanges at around 150, but according to PricewaterHouseCoopers Health Research Institute, they can be broken into four types. Barbara Gniewek, principal and private exchange lead with PwC in New York City, explains these are grouped based on their genesis, or their beginnings.

  • Technology: This includes such companies as bSwift and Benefitfocus; many developed public exchanges in states that built their own, PwC says. Others are known for providing benefits administration as either an outsourced solution or enrollment for insurers. “They are like the vending machines [of private exchanges]; they provide infrastructure and you decide what products you want and what brands to have,” Gniewek says. “They are highly flexible.”
  • Pure Play: These are very new technology infused and highly flexible systems that include such companies as Liazon. They are like a pre-stocked vending machine as they come with products on the shelves, including medical plans with certain carriers, Gniewek adds.
  • Broker/Consultant: Calling these “really interesting,” Gniewek says they are built on technology platforms. They include such companies as Aon Hewitt and Arthur J. Gallagher & Co. Some of these are built in-house by the broker or consultant, but in many cases, are the result of partnering with a technology company
  • Insurer: Including such companies as Cigna and Aetna, their strategy was to build their own private exchange to protect market share and separate themselves from the competition. The insurers, Gniewek adds, may also have relationships with networks and have clients they want to protect. Many of these also use technology developed by others.

So how does an employer pick which model to choose? Employers often rely on their advisers, including brokers and consultants – many of whom have their own exchanges. Gniewek says when PwC helps a client they do two main things as an evaluation:

First, an understanding what the employer is looking for, including making their own plan design or enhancing a strategy they already have. “Depending on what they are looking for, exchanges that meet their needs can differ greatly,” she says.

PwC also helps employers understand the different models and which plays to their employee size. “Which ones can best meet [employer’s] needs?” she asks. “That is what the consultant needs to do.”

3 questions to ask before moving to a private exchange

Originally posted July 24, 2014 by Andrew Bloom on

As employers grapple with how best to deliver health insurance to their employees, the concept of private insurance exchange or marketplace is quickly gaining traction. In a private exchange model, rather than continuing to assume the responsibility for making healthcare decisions for plan participants (or managing the risk on their behalf), an employer transfers responsibility to employees. This transfer of power enables employees to make important decisions on behalf of their families. Employers have something to gain, too: predictable healthcare costs.

But there is more involved here than simply choosing a private insurance exchange over a traditional benefits delivery model. This is not a simple switch you flip. In fact, the move to a private exchange could be difficult for employees who generally are not accustomed to making benefits plan decisions for themselves, or who balk at the potential of an increased out-of-pocket burden. It’s incumbent upon employers to guide them through the transition to help them accept the idea that having more power and choice is a good trade-off to taking on more risk. To do this, the employer must introduce a defined contribution approach to the workforce and embrace concepts like premium transparency, fixed dollar contributions and multiple plan options.

When done properly, a private exchange will help you achieve the three C’s of benefits: consumerism, compliance and cost-containment.

In short, there’s a tremendous upside toward embracing this strategy, which is a reason why most employers are investigating the option of private exchanges. For virtually every organization, it is not a matter of “if” joining a private exchange is right; it is a matter of “when.”

The key to answering “when” a private insurance exchange is right for your organization starts with understanding where you are on the course. This will help you determine what tools and resources are necessary to help get you there.

Here are three simple questions to consider:

1. How do your employees enroll in benefits today?

2. Do you have a health/wellness and cost management strategy in place?

3. How active are your employees in your current benefits decision-making process?

Depending on the answers to these questions, you may need to:

  • Alter your benefits philosophy and design benefits plans and programs to help you move further down the path on the engagement spectrum.
  • Design an aggressive wellness and health management strategy. While a private exchange may provide short-term cost savings, it is not a silver bullet.  You must continue to drive better behaviors to control costs associated with your program over the long term.
  • Execute an ongoing communication strategy that educates employees to become smarter consumers of benefits and better prepared to accept the responsibility and risks associated with making healthcare decisions.
  • Implement benefits administration technology that will allow you the flexibility of managing your current program as well as a private exchange, thus affording you the flexibility of a smooth transition.
  • Leverage an experienced third party, regardless of implementing a private exchange, to manage the administrative complexities and ever-changing regulatory requirements surrounding your benefits program. This is critical to eliminating costly mistakes and ensuring regulatory compliance.

Before pushing off from the starting line, consider if your organization and employees are ready for such a significant shift in benefits delivery. Keep in mind that preparation for a private exchange is a bit like running a relay. Before the starting shot is fired, everyone in your organization must fully trained to make it around the track.

Employers have an opportunity to transform the delivery, management and overall outcome of their health and welfare programs for the better. A private insurance exchange will be a critical component of your benefits program, but only after you determine your readiness and strategy before taking the first step.

Employers taking 'bold steps' with health benefits

By Kathryn Mayer

Don’t count on employers to stop offering health benefits altogether, but do count on big changes in how they offer the benefits.

That’s the main finding from recent analysis by Aon Hewitt. The vast majority of large and mid-size U.S. employers — 94 percent — say they’ll continue to offer health benefits to their employees in the next three to five years, but almost two-thirds plan to move away from a traditional “managed trend” approach to one that requires participants to take a more active role in their health care planning.

The consulting firm surveyed nearly 800 large and mid-size U.S. employers covering more than 7 million employees.

“The health care marketplace is becoming increasingly complex,” says John Zern, executive vice president for Aon Hewitt. “New models of delivery, new approaches to managing health and new compliance requirements are challenging employers to think differently about their role in owning health insurance responsibilities for employees and their dependents.”

Aon Hewitt says the amount employers spend on health care has increased by 40 percent in the past six years to approximately $8,800 per employee. Meanwhile, employee premium and out-of-pocket costs have increased 64 percent to almost $5,000 per year. Aon Hewitt estimates that health care costs for both employers and employees will continue to rise 8 percent to 9 percent per year for the foreseeable future.

Zern says though employers are staying in the health benefits game, they are taking “bold and assertive steps to achieve more effective results” — and they are doing so at a faster pace than has been seen in previous years.

Almost 40 percent of employers expect to migrate toward a “house money/house rules” approach in the next three to five years. For example, participants who take health risk questionnaires and biometric screenings may be rewarded in the form of lower premiums or access to broader health coverage. Other employers may waive prescription drug co-pays if an employee demonstrates they are following their doctor’s orders with regard to a chronic condition. Lastly, some leading-edge employers are working with health plans to incentivize participants to use a small provider network of high quality, cost-efficient providers, Aon Hewitt finds.

Though just 6 percent of employers plan to exit health care completely in the next three to five years, 28 percent say they’re planning to move to a private health care exchange.

Jim Winkler, chief innovation office the U.S. Health & Benefits practice at Aon Hewitt, says that private exchanges are an “increasingly attractive option” to organizations that want to offer employees health care choice while lowering future cost trends and lessening the administrative burden associated with sponsoring a health plan.

“The allure of exiting completely is strong until you look at the numbers,” Winkler said. “Between the Affordable Care Act penalties for failing to offer coverage and the ensuing talent flight risk, most employers believe they need to continue to play a role in employee health, but want a different and better outcome.”


Exchange Picture

Only 18 states and the District of Columbia announced that they plan to set up their own health care exchange under the health reform law by the Dec. 14 deadline set by the Department of Health and Human Services. The remainder of the states will rely on the federal government to establish and run their exchanges.