Defined Contribution The Next Frontier of Healthcare Consumerism. IHC Forum East - May 2013 Presenter: Terry McCorvie
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1 Defined Contribution The Next Frontier of Healthcare Consumerism IHC Forum East - May 2013 Presenter: Terry McCorvie 1
2 Changes in the market place are creating challenges but also present opportunities Increasing Healthcare Costs MLR? Aging Population PPACA Brokers/ Consultants TPAs/ Health Plans Providers Pharma Employers CDH? Defined Contribution? Private or Public Exchange? Tax Reform Financial Institutions Hospitals Consumers Play or Pay? Cadillac Tax?
3 Defined Benefit Dilemma I m Lactose Intolerant Looks a little greasy. Is it glutenfree? I ll be nice and order a big pizza for everyone Vegetarian Here! Sue
4 Shift to Consumerism I ll have Chinese. Can you say taco? Chicken here! They re happy, but this takes way too much time and effort My favorite salad, please.
5 Defined Contribution Solution Cheeseburger & Fries. I m thinkin club sandwich. I m gonna go for a salad. I knew my exact cost and everyone picked just what they wanted Just some fruit for me.
6 Defined Contribution Solution Just an HSA Plan for me I want direct access to my specialist Gotta have orthodontic coverage I knew my exact cost and everyone picked just what they wanted I need the best plan for my family
7 Shift to Defined Contribution Shifting more responsibility to the consumer DEFINED BENEFIT CONSUMERISM DEFINED CONTRIBUTION Traditional Consumer Directed Exchanges & Health Insurance Health Plans Plan Choice Employee Employer Limited benefit choices Co-Pays Plan Selection & Design Subsidized Premiums Limited flexibility for funding CDH & HDHP More responsibility for healthcare spend Limited benefit choices Plan Design Tools Premium Subsidies Account Contributions Some flexibility for funding Consumer for health insurance products Increased benefit choices More responsibility for benefit selection & purchase Alignment to Employee s needs Fixed Contribution Greater flexibility for funding FSA FSA, HRA, HSA Transparency Tools Engagement FSA, HRA, HSA Plan Selection Tools Engagement 7
8 What is defined contribution? A fixed contribution from the employer to be used by employees to help pay for benefits
9 Defined Contribution Marketplace X Partners Provide Plans and Rates $5,000
10 What s driving the shift to Defined Contribution? 5.7M 112M Total employers in the U.S. Total employees in the U.S. 33% 35% % 19% Employees by Company Size 1,000-4,999 5,000+ $10,000 per employee COST Health care costs have rose above $10,000 per employee for the first time in % The number of employers committed to offering coverage in who believe private exchanges are the preferred 44%Employers approach for delivery. Sources: U.S. Census 2010, Aon Hewitt
11 Why now? Advanced Web Capabilities On demand education Expense trackers Plan and cost comparisons Employer Costs Going Up Medical inflation Uncertainties caused by reform Employee Costs Going Up Higher deductible Higher out-of-pocket Demand for a retail market model Trade Off Fixed employer contribution More employee choice
12 Advantages of DC Carrier Broker TPA Employer Employee New distribution channel Highly efficient acquisition and maintenance Automate client segments Retain client base through self-service Positioned to perform back room functions Agnostic in the market, CDH-COBRA integration Fixed annual budget Significantly simplifies administration More choices, retail market engagement Pre-tax Savings Options
13 Myths about Defined Contribution DC is a new idea Retiree plans for years Employer Flex Credits Managed Competition 1990 s DC is just for large employers Technology pushing downmarket Smaller employers most in need ACA play or pay exempt Automation strategy for brokers DC requires individual insurance Works with group or individual Many carriers more comfortable with group Employer can still control spend Individual or Group? DC will cure medical inflation Consumer engagement Retail provider accountability/transparency
14 Group or Individual Defined Contribution Individually Underwritten Policies Employee goes to health plan, broker or State Exchange Employee pays for premiums out of pocket Employee potentially reimbursed from a premium reimbursement account** **Subject to regulatory rules Individual Insurance Group Insurance Private Exchanges Group Underwritten Policies Employer Sponsored Exchange Single & Multi Carrier options Broad Plan Array for employees Direct integration with payroll Maintain broker/consultant relationships Whether group or individual insurance is offered, every employee shops in a private exchange Exchanges support both insurance models separately or a combination of both Tight integration with CDH, Wellness and COBRA provide a robust health/wealth management tool
15 Critical for Success Management/Employee Buy In Education before the change Consumers must see it as a benefit Preparation reduces the noise Robust Online Shopping On-demand education Quick and easy to use Insurance and savings options Benefit Cycle Management Money Management Follow the money Payroll deduction management Multiple Plans, Multiple Payments Sources Bill/Collect/Disburse Choice Management Ability to limit recommendations Purchase tracking/filtering Benefit partner reconciliation
16 Plan Recommendations 16
17 Purchase/Cost Tracker 17
18 Private Exchange Space is Crowded Partnerships are starting to form Technology Acquired Partnered Partnered Health Plans Partnered Acquired Partnered Partnered Acquired Brokers Partnered Acquisition & Organic Partnere d Partnered Acquired Other Participants
19 Growth in Defined Contribution for Healthcare and Exchanges (HIX) Private Exchange Adoption Benefit Innovation Growth Curves 100% 50% % of employers who would consider switching to a private exchange 90% 80% 70% 60% 50% 40% 30% 20% 20% 26% 26% 62% 57% 55% 23% 49% Market Share 40% 30% 20% 10% CDHP 10% 0% 10 to to to 3000 >3000 Would consider switching as long as they saw savings of at least 10% Would consider switching for no savings 0% Year PPO HMO k CDHP Source: Oliver Wyman survey 1,329 employers, weighted based on employer size, December Source: McNeill, Dwight Putting Consumers at Risk: An Evaluation and Interpretation of Consumer Driven Health Care. Doctoral Dissertation, Brandeis University 19
20 Growth in Defined Contribution for Healthcare and Exchanges (HIX) Recent Surveys on Employer Attitudes Towards Health Benefits 44% of employers are considering DC models 81% of employers prefer private/dc exchange to public 28% of employers interested in DC approaches Receptivity to DC is high Early stages in the market & high variability 2013 will be critical to establish presence although adoption may push out to % of employers confident private exchanges are viable alternative; 21% likely to gravitate to DC Source: Triple Tree Market Update: February 21,
21 Legal Compliance There are specific rules that must be followed The rules vary Size of Group Group vs Individual What contribution is for
22 Lessons Learned Over 15 Years Carriers are NOT nimble Key contacts imperative Must understand rule sets Map EDI to them Follow the Money Need to Own Billing and Payment Consumer by Consumer, Plan by Plan Real Accounting Functions Accrual vs Cash Reconciliation - Exceptions $ $ $ $ $ Centralized Service Triage and routing Everyone must consider it a partnership Must be easy to use Change is constant New plans, new rules, new partners New government requirements, regs
23 Private Exchanges will expand beyond Healthcare Insurance Expansion Drivers As the marketplace matures, employers and employees will look for continued benefits consolidation Employers benefit from consolidated list billing for group insurance Employees also can receive consolidated list bills for individual product(s) Supplemental Insurance Disability (ST & LT) Life Accident Pet??? Incentives & Wellness 23
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