The Potential Value and Challenges of Public and Private Health Insurance Exchanges for Employers

Transcription

1 The Potential Value and Challenges of Public and Private Health Insurance Exchanges for Employers Donald P. Weber, Managing Director, PwC Larry S. Boress President and CEO Midwest Business Group on Health Mid-America Coalition on Health Care May 14, 2014

2 Agenda Employers and Health Benefits What is a Health Exchange Introduction to the Private Exchange Evaluation Collaborative (PEEC) Employer Views and Intentions Related to Private Health Insurance Exchanges - Survey Findings The Landscape of Private Health Insurance Exchanges RFI Results MBGH and PwC Services for Employers Questions from Participants 1

3 Why are employers still offering health care benefits and wellness activities? To recruit and retain talent To increase productivity by ensuring a healthy workforce To respond to a health system that fails to effectively focus on prevention or management of chronic conditions To take advantage of the hours a year employees are at work, to educate, motivate, inform, train, and treat their populations To incentivize workers to take responsibility for own their health To reduce lost work time and absenteeism by making preventive, acute and primary care services available onsite and easily accessible The ACA and development of private health insurance exchanges do not change any of these factors for employers PwC 2

4 Employer views on the value of health 95% of employers agree that there is a link between an employee s health and their productivity 84% of employers believe that health benefits are a necessary cost of doing business 85% of employers view health benefits as an investment in human capital with a measurable outcome Source: 2008 MBGH Readiness to Change survey PwC 3

5 Employer Challenges: To reduce health benefit costs and improve the health of the covered population Competing on a global market against non-us employers who don t have to add the expenses of health benefits to their product/services Facing a 2018, ACA 40% excise Cadillac tax on benefits above the designated cost levels Ensuing access to primary care for their populations since in 2014, another 3 million people will have access to insurance Key areas of focus for employers: Chronic disease: 80% of health benefit costs Specialty drugs: projected to represent 40% of drug costs Preventing illness Reducing risk factors Motivating workers to make better elective health care choices Providing access to primary care and ancillary services Outsourcing benefit administration PwC 4 Competing on a

6 Low Non-Participant Med Risk High Employers need to find ways to reduce risk of their covered populations Keeping people healthy reduces costs Annual Medical Costs $12,000 $9,000 $6,000 $3,000 $0 $7,991 $10,785 $7,989 $5,710 $6,625 $8,110 $5,114 $6,636 $4,620 $5,212 $3,353 $3,800 $2,565 $5,756 $2,944 $4,613 $3,734 $1,414 $2,740 $1,776 $2, Age Range $11,909 $11,965 $8,927 *Edington. AJHP. 15(5): , 2001 PwC 5

7 Exchanges: Not a new concept Public exchanges are new but not private exchanges Employers who offer multiple benefit options, have online portals and set the percent of their contributions have had an exchange for years Even 3 rd party private exchanges have been around for years Active exchanges in CA since 2005 Retiree exchanges since 2005 The difference now exchanges are: Gaining traction CEOs are hearing about them and asking HR if this should be part of the firm s benefit strategy Becoming common language Viewed as 3rd party benefits in a box marketplaces Leveraging more technology Offering to take over all benefit functions PwC 6

8 What is a Health Insurance Exchange? An on-line marketplace where individuals can purchase medical and / or other benefits A health insurance exchange (HIX) can be: Public (run by government) or Private (run by industry) Group or individual Fully insured or self-insured Defined contribution, or not Single or multi-carrier Health (medical, Rx, dental, vision) only options or many other coverage options (life, disability, theft identity, pet, legal, other voluntary) Limited or robust decision support Owner / steward of benefit choices and options decisions Integrated with consulting services, or purchasing coops, or other services Integrated with health care services: wellness, care management, others Integrated with certain benefit administrative functions But, one thing is for sure, they are all different and they are evolving 7

9 Private Exchanges for Actives: 4 different types, many different value propositions The private HIX market is getting crowded as new entrants jump in. With low hurdles to entry, we expect the market to expand before it contracts. Carrier Broker / Consultant Technology Pure Play 8

10 Key differences between Private Exchanges Stewardship High Low Enabling consumerism FI or SI Integrated DC or other contribution approaches Fees and commissions Financing Store / Shelf Single or multicarrier Prepackaged options or flexible Health Only Life, disability, HSA/FSA Voluntary: vision, pet, legal, telemed, etc. Products Decision support Comparisons Recommendation software Education Call centers On-line chat Care Mgmt. High Low 9

11 Exchange Technologies Technology typically falls into two categories: Exchange specific technologies that are vendor agnostic - Key players include: Benefit Focus: powers several carrier exchanges, as well as Mercer and other brokers, and directly contracts with large employers bswift: powers several state exchanges, just launched its own exchange, powers some brokers exchanges Liazon: distributes its own exchange and powers several large broker exchanges (Gallagher, Willis, Lockton, USI, HUB), was acquired by Towers in November 2013 Build out of legacy ben-admin systems, often sold as a part of benefit outsourcing: Aon Hewitt, Towers and Buck 10

12 The promise of private exchanges Each private exchange is different and selecting the right exchange must be tied to an employer s strategic objectives. The promises of private exchanges Cost Reduction through: Employees buy down / right size Reduced fees due to group purchasing Defined contribution Increased carrier competition Increased consumerism / engagement Insured products = reduced volatility Network savings: Best in area discounts High performing / narrow networks ACOs, COEs Co-ops: PBM, Life, Disability, Stop Loss Integrated care management and wellness Consistent experience over life Reduced administration Other things you need to know Costs: Exchanges have costs associated with them, but differ: Pure Play / Carriers: Employers pay a user fee, plus an implementation fee. Some HIXs receive fees from vendors Consultant / Broker: sometimes collecting an exchange fee, commissions from carriers and rebates from PBMs. They will likely require BOR letters. Bundled Services: Consultants and brokers are presenting bundled products that include consulting, reporting, co-ops, and will not unbundle Independence: Firms concerned that their advisors sponsor exchanges 11

13 Benefit Selection Participation Product 80 % Buy different health insurance, vast majority of which buy down 75% Dental 70% Disability 65% Buy HDHP, with 80% opening HSAs 45% Vision 40% Life 30% Supplemental health 10% LTC, Tele-Doc, Pet, wellness, etc. *Data from Liazon

14 Active Private Exchange Market Exchange Owner Launch Clients / Members 2014 Corporate Exchange Aon Hewitt / 600,000 Right Opt Buck / 225,000 Mercer Marketplace Marsh / 115,000 One Exchange Towers Watson / 45,000 Bright Choices Liazon / Towers / 100,000 Bloom HCSC, Anthem, BCBSM, private / 90,000 Benefit Focus Benefit Focus , 30+ / 20 M bswift bswift , states / 3 M Aetna, Cigna, UHC Aetna, Cigna, UHC Mid

15 Retiree Private Exchange Market Exchange Members Since Owner/consultant OneExchange 500, Towers Watson Aon Hewitt Navigators 100, AonHewitt Connector Model 75, United Healthcare (Mercer) Retiree Health Access / Aetna Marketplace 100, HR Policy Assoc / Aetna RightOpt 50, Buck Consultants (Xerox) Transition Assist < 20, Transition Assist, LLC / Marsh Conexis < 20, Conexis HealthPlanOne Medicare Solutions 40,000 N/A HealthPlanOne, LLC 14

16 What is fuelling the growth in private exchanges? Continued increase on health care costs is forcing some employers to consider capping their contributions Intermediaries (consultants/brokers) see a new opportunity to expand their roles across the supply and demand chain, increasing /solidifying outsourcing and consulting opportunities. Carriers are following to protect their market share and to sell additional products Move to public exchanges may decrease payer margins causing payers to consider alternative solutions such as private exchanges Promise of cost savings 15

17 Private Exchanges are a disruptive market influence that have the ability to change the way employers provide benefits It has only just begun Private exchanges are gearing up for growth - Value proposition will continue to evolve - One size will not fit all: employers will use to pull back from and lean into providing benefits - Point of View will extend beyond enrollment - Blurring of lines between PIX and health plans New exchange technology is enabling rapid adoption - Minimal barriers to entry - Reduced implementation timeframes - Can be more flexible and allow more customization Transparency is more complicated - Potential for hidden sources of expense, including PBM arrangements - Need for fiduciary oversight 16

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19 The Private Exchange Evaluation Collaborative (PEEC) An initiative launched by four leading nonprofit business coalitions and a leading independent consulting house, not sponsoring exchange: Employers Health Coalition, Inc. Midwest Business Group on Health Northeast Business Group on Health Pacific Business Group on Health PwC PEEC Objective: To solicit and provide unbiased, comparative information and support on private exchange strategies and purchasing decisions. 18

20 PEEC Employer Survey Key Findings: Employers are considering exchange-based benefits strategies, but the path forward is far from clear. 45% of employers have implemented or plan to consider HIX 15% of employers are or will consider encouraging FTEs to go to the public HIX 58% would consider contributing to the public exchange if permissible The greatest barriers to private exchange adoption relate to their immaturity and uncertainty about their longer term stability. 19

21 Employers are looking for comprehensive services from private exchanges Important to Employers Important to the Consumer & Shopping Experience Flexible employee contributions Tools that aid in plan selection Cost of plan options Ease of use Administrative & claims advocacy Broad network access Implementation assistance Experience & track record Financial stability Employee communication support Call center/ Instant chat Variety of plan options & designs Reduce Benefits Staff s Admin. Effort Data & Reports Level and transparency of fees Portal with care management & claims info. Health education tools & library High performing networks PwC 20

22 PEEC Employer Survey Key Findings: Interest in private exchanges extends across industry segments and employer size while the importance of some requirements do vary. Almost half of employers expressed interest in considering private exchanges for full-time employees by 2018 with limited variation by industry Almost half of employers indicated that it was very important to have a self insured option with somewhat less interest by small employers Slightly more than one third of employers indicated that it was very important to have a fully insured option (about ¼ of larger employers ) Over half of large employers indicated that flexibility within [their] contribution strategy is very important 21

23 PEEC Employer Survey Other Interesting Insights: 69% of employers agree that it is very important to have independent advisors 25% of employers think that private exchange s will save them money 39% are unlikely to adopt a defined contribution approach in the next two years, but firms favoring DC are more likely to consider implementing a private exchange 22

24 PEEC Employer Survey Key exchange benefit designs are considered important by employers Broad provider network access Variety of health plan options Wide selection of plan designs High performing networks Wellness incentives ACOs and new payment models Ancillary products Narrower networks 0% 20% 40% 60% 80% 100% Very Important Somewhat Important 23

25 Interest in Defined Contribution Varies Very Likely, 4% Already Adopted, 9% Very Unlikely, 21% Somewhat Likely, 21% Somewhat Unlikely, 18% Neither Unlikely nor Likely, 27% PwC Private Exchange Evaluation Collaborative, 2014 All Rights Reserved 24

26 PEEC RFI Current Initiative: So far, 25+ exchange responses in database Information solicited included: Background, strategy, clients Products and partners Consumer experience Administrative requirements / capabilities Financial parameters Information is preliminary 25

27 Value Proposition 26

28 Sources of Revenue 27

29 Rx Options PBM Options 17% 17% 66% Managed by Med. Carrier, no PBM choice Carved out, w/o PBM Choice Carved out, w/ PBM Choice The PBM deals are pre-baked, and inflexible except for custom stores. Some consultant / broker models leverage co-ops. 28

30 Member Enrollment Tools 29

31 Member services available 30

32 Educational Information Offered 31

33 Decision Support Factors Considered in Ratings 32

34 Not all provide eligible employee assistance in accessing public marketplace subsidies 33

35 Option Customization and Funding 34

36 Performance Guarantees Vary 35

37 Implementation Challenges

38 Implementation Timeframes vary by Vendor and size of Employer 37

39 Reasons employers are cautious about private exchanges Immaturity of private exchange Stability of cost over time Stability or track record of exchange Limited info for employers re: private Employee readiness Inconsistent with organizational culture Regulatory uncertainty Geographic variation in plan offerings 0% 20% 40% 60% 80% 100% Strongly Agree Somewhat Agree 38

40 Other potential barriers to employer adoption Difficulty in exiting/changing exchanges Loss of flexibility in tailoring plan design Loss of control or stewardship Loss of indep. oversight of experience rating Ability to limit carrier options Requirement to be fully insured Requirement to be self insured 0% 20% 40% 60% 80% Strongly Agree Somewhat Agree 39

41 Observations Consultants / brokers exchanges are gearing up for significant growth related to exchange business. Some require use of their benefit s administration and/or consulting services Implementation timeframe is less for those leveraged by exchange technology partners Exchanges leveraging exchange technology partners tend to be more flexible and allow more customization Exchanges are collecting several different levels of fees from employers and vendors. It is very important that employers understand the revenue earned by the exchanges based on the services and products provided The PBM arrangements and potentially other cooperatives may be generating more exchange revenue. Understand requirements for vendors and products Role of Exchange versus role of Carriers unclear 40

42 Midwest Business Group on Health and PwC Services for Employers Understanding the private exchange environment and the current vendor products and services Evaluating if a private exchange is the right option for them Analysis and selection of a private exchange vendor using PEEC database and targeted RFP Research into the impact of private exchanges on their market or products 41

43 Questions from Participants 42

44 Contact Information Larry Boress President & CEO Midwest Business Group on Health ex 101 Donald P. Weber Managing Director, PwC PEEC LinkedIn Group 43