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A Buck Consultants webinar Sherri Bockhorst, Sharon Cohen, and Barry Hall March 19, 2013 Exchanges: are they right for you? March 19, 2013
A Buck Consultants webinar
Sherri Bockhorst, Sharon Cohen, and Barry Hall
March 19, 2013
Exchanges: are they right for you?
March 19, 2013
A Buck Consultants webinar
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March 19, 2013
Today’s areas of focus
• The current health insurance exchange landscape
• The RightOpt™ exchange
• Creating a sustainable employee engagement model
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Sharon CohenPrincipal,
Knowledge Resource Center
Barry HallPrincipal,
Talent and HR Solutions
Sherri BockhorstPrincipal and
RightOpt Leader
A Buck Consultants webinar March 19, 2013
The current health insurance exchange landscape
A Buck Consultants webinar
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March 19, 2013
ACA pressures on health care expenditures
Direct fees / taxes on the plan• PCORI • FSA Limit • Transitional Reinsurance • Cadillac Tax
Indirect fees / taxes on the plan• Pharmaceuticals companies • Medical device manufacturers • Insurers
Benefit mandates • Dependents to age 26• Annual / lifetime limits• Preventive services• Grievance and appeals procedures
• Comparative effectiveness research
• Medicare quality initiatives• Reduction of hospital bad debt • Migration to state exchanges
Other• Employer mandate • Individual mandate• Medicare payments• Medicaid expansion
A Buck Consultants webinar
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March 19, 2013
What is an exchange?
Ex�change: noun, often attributive
From Merriam-Webster
• A place where things or services are exchanged, such as a store or shop specializing in merchandise, usually of a particular type
From Dictionary.com
• To give and receive (information, ideas, etc); interchange
• A central office or central station
From Wikipedia
• Exchange may refer to:
• Finance and commerce, communications and technology, music,
mathematics, physics, places
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March 19, 2013
• Insured and self-funded plans
• Customized
• Standardized
• Health plans
• Provider organizations
• Business groups
• Consulting / brokerage firms
• Independent exchanges
Primarily:
• Mid to large group employers
• Varies by developer focus and contracts
Health care exchanges
• Qualified health plans (QHPs)
• Medicaid / SCHIP
• Catastrophic plan (“young
invincibles”)
Types of plans
• State-based (17 states + DC)
• State-partnership (7 states)
• Federally facilitated (26 states)
• CO-OPs
Developers
Public Private
Primarily:
• Individuals
• Self-employed individuals
• Small group employers (≤100)
Buyers
A Buck Consultants webinar
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March 19, 2013
A Buck Consultants webinar
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March 19, 2013
Public Exchange plan options
Platinum Gold Silver Bronze90% 80% 70% 60%
A Buck Consultants webinar
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March 19, 2013
The big unknown
Public Exchanges
• Will they be able to deliver what they promise?
• Who will be better off buying health coverage through a public Exchange?
Private Exchanges
• What can they deliver?
• Will they be able to offer quality benefits at less cost?
A Buck Consultants webinar March 19, 2013
The RightOpt™ exchange
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March 19, 2013
Xerox: Health care ecosystem change agent
of US patients touched
by Xerox services 2/3
claims
processed
annually900M+
of top 20 managed
health care plans are
clients20
hospitals using
MIDAS+800
states are Medicaid
clients36Xerox is helping ensure the health of
both people and businesses.
A Buck Consultants webinar
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March 19, 2013
Approaches to plan engineering
Fundamental
Sole sourced with
limited carve-out
Cohesive
Integrated best-in-class components
Complex
Multiple vendors
and service
providers
RightOpt
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March 19, 2013
Multiple options working together
VBIS:PT actives
Portfolio of
indemnity plans that
allow for improved
design and rate
stability along with
enhanced
administration to
support member
engagement.
My Medicare Advocate:Retirees
Provides multi-
carrier insured
individual products
through a defined
contribution model.
RightOpt:FT actives
Leverages best-in-
class partners to
reduce trend
through vendor
optimization, group
purchasing
efficiencies, and
improved
population health.
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March 19, 2013
RightOpt: It’s more than just “insurance”
AuditsTele-
medicine
Personalized experience
Data integration
HPNs / transparency
Direct contracts
Pharmacy
Biometrics and assessment
Lifestyle coaching
Incentive platform
EAP and advocacy
Medical and supplemental
Dental Vision
We help members choose, use, and improve:
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March 19, 2013
The right option
• Preferred partners
• Stringent performance and financial requirements
• Drives cost out of the delivery system
• Saves employer and employees money
1. Best-in-class
• Promotes healthier workforce
• Personalized interactions
• Improved productivity
• Reduced health care trend
2. Holistic
• Choice of plan designs and incentive structures
• Tailored to the organization’s culture
• Self-funded or fully-insured basis
3. Flexible
A Buck Consultants webinar March 19, 2013
Creating a sustainable employee engagement model
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March 19, 2013
Overcoming typical health engagement barriers
Fear for personal data privacy; distrustful of employer’s intentions
Too time-starved, recession-fatigued, or work-life stressed to engage
Impatient with the hassle factor (steps involved) in employer or vendor programs
Low sense of personal responsibility for health; denial (“I’m fine”)
Trust
Time
Tolerance
Traction
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March 19, 2013
New approach for health engagement
Old Model
• Static
• One size fits all
• Activity focused
• Paternalistic
New Model
• Dynamic
• Audience of one
• Outcome focused
• Shared accountability
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March 19, 2013
Levers that drive engagement
• Vendor partners
• Technology
• Individualization at time of need
Resources, services and
tools that enable
individuals to take action
Infrastructure“I’m able to…”
• Plan design
• Rewards/penalties
• Social/behavioral techniques
Motivators to get attention
and encourage greater
individual accountability
Incentives“I want to…”
• Communication
• Branding
• Personal data
Elements that educate and
promote your benefits and
build personal awareness
Information“I understand…”
• Leadership support
• Environmental support
• Social contract mandates
Mandates that enforce
accountability for specific
behaviors and actions
Imperatives“I must…
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March 19, 2013
RightOpt portal – foundational principles
• Aggregate tools and information from multiple vendors into a single integrated site accessible by all
employees, spouses and retirees
• Boost engagement by creating a
simplified experience that reduces
barriers, is interactive, fun and
engaging, captures interest, rewards
curiosity and casual exploration, and
encourages return visits
• Create and manage a consistent brand and message across all consolidated health and
wellness resources
• Drive behavior changes by suggesting targeted, relevant action items and nudges
• Promote and administer incentive rewards for multiple activities in a consistent manner
• Provide a platform for messaging that meets the needs of the plan rather than vendors
RightOpt
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March 19, 2013
Make it personal and relevant
Personalized interests
Know your
numbers
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March 19, 2013
Drive actions and outcomes
Personalized recommendations
Targeted messaging
Incentive
rewards
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March 19, 2013
Make it simple and interactive…
Interactive
digital media
Animated site tour
Shopping cart
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March 19, 2013
…accessible and convenient
Health screening scheduling tool
QR Codes
Mobile access
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March 19, 2013
Apply behavioral science
Statistical optimism
Regret aversion
Loss aversion
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March 19, 2013
Use social influence
Social media
affinity groups
Employee testimonials
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March 19, 2013
Make it sticky and fun!
Lifestyle
modelerInteractive games
Avatars
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March 19, 2013
Xerox research and innovation
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March 19, 2013
The science of engagement
Persuasive computing
contextual targeting, behavioral science
Social media/ Gamification
relationship influencers, fun factor
Ethnography
behaviors & attitudes,
social cognition
Predictive analytics
interests, topics,
patterns
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March 19, 2013
Evaluating exchanges
What’s included?
• Insurance products, administration capabilities, and decision support tools for the
employees both during enrollment and throughout the year
How much can you customize?
• Ranges from complete customization to a fixed set of both carriers and plan designs
How sustainable is the solution?
• Determine what happens after year one to both the employer and the employee
costs
How much choice is right for your employees?
• Complexity of decisions you are asking your employees to make, the adequacy of
the support they will have to make decisions, and if those choices truly add value
What role does HR now serve?
• Understand your role after the exchange is deployed to ensure you are not too far
removed from your data to be able to impact the productivity of your workforce
A Buck Consultants webinar March 19, 2013
Questions?
Sherri [email protected]
314.719.2630
Sharon [email protected]
202.776.1027
Barry [email protected]
617.275.8033
