Every year Towers Watson customer support staff receives thousands of calls from people using OneExchange to find and enroll in health plans. The questions they ask us — and their employers –tell us a lot about what’s important to them and the information and guidance they need to make the best decisions they can.

With a growing number of full-time employees using OneExchange to find health coverage, we decided to compile the top 10 questions asked during the recent fall enrollment period for the plan year 2015. The questions underscore the obligation that employers and exchange providers have to help employees become more informed consumers and more active participants in their own health care.

Earlier this month, we issued a press release with a list of the top 10 questions and what they reveal about employees’ concerns.

Click here to read the full release.

Last month, both the House of Representatives and the new Republican-controlled Senate introduced legislation that would change the definition of a full-time employee under the Patient Protection and Affordable Care Act (ACA) from 30 to 40 hours per week. The House version of the bill passed on January 8, 2015. The Senate version has been referred the Finance Committee.

The stakes are high. The ACA’s employer mandate now requires employers with 100 or more full-time employees to provide health insurance that includes a set collection of benefits laid out in the ACA, or pay a penalty. This “pay or play” employer mandate goes into effect for employers with 50 to 100 full-time employees in 2016.

President Obama has promised to veto any bill that walks back provisions of the ACA and this bill in particular. It is unclear that either the House or the Senate could muster the two-thirds vote required in both chambers to override his veto.

Proponents of the bill argue that raising the cutoff for full-time work to 40 hours per week would take pressure off employers and lessen the chances they would cut workers’ hours to under 30 per week to avoid having to provide health insurance.

Opponents argue that employers are more likely to cut hours if the threshold is 40 hours per week, putting many workers in the 35 to 39 hours per week range at risk of becoming part time under the law.

The debate will no doubt continue.

However, the 2014 Towers Watson Health Care Changes Ahead Survey offers insight into the focus of U.S. employers’ planned response to the ACA’s employer mandate. Completed in July 2014 by 379 employers that collectively employ 8.7 million people, the survey revealed that 75% of employers plan no changes to their workforce strategy or mix of part-time employees in 2015 or 2016. Moreover, 91% of employers that offer health plans to part-time employees are “not at all likely” to discontinue them in that timeframe.

Ben Lupin, senior regulatory advisor for Towers Watson Health and Group Benefits, cautions employers not to count on the passage of a bill redefining full-time work as 40 hours a week. “The stakes are too high,” says Lupin. “Better to act as if the 30-hour cutoff is set in stone and move forward accordingly. When the option is to ‘pay or play,’ paying a penalty is simply too onerous to consider.”

For additional insights from Lupin on the “pay or play” option, see our blog post on the ACA reporting requirements that went into effect on January 1, 2015, here.

In 2014, nearly three-quarters of employers offered their employees one or more account-based health plans (ABHPs). Another 9% expected to add an ABHP to their plan options for the plan year 2015. In addition, 16% of employers now offer ABHPs as the only plan option, more than double the rate in 2012. No other plan types saw such positive growth in 2014.

This is according to data from the 19th Annual Towers Watson/NBGH Employer Survey on Purchasing Value in Health Care, fielded in late 2013/early 2014. Respondents included 595 employers that 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.

An ABHP is an employer-sponsored health plan that combines a high deductible with either a Health Reimbursement Arrangement (HRA) or Health Savings Account (HSA) – tax-advantaged accounts that employees can use to pay eligible health care expenses. ABHPs help employees increase their understanding of the value of the benefits that their employers provide.

The survey further revealed that in 2014, employee enrollment in ABHPs increased from 15% to nearly 33%. When offered on a private exchange, uptake was even higher, with 40 to 60% of employees enrolling in ADHPs. To make ABHP adoption even more attractive, 79% of companies that offer them contribute subsidies for their employees into the tax-advantaged savings accounts the plans are connected to.

However, there is a learning curve that comes with being a newly empowered health care consumer. And the first year of implementing an ABHP can be difficult on employees because it takes time to accumulate funds in the accounts the plans are attached to. In the meantime, employees might have medical expenses that are not covered and exceed the funds in their accounts. Employers looking to adopt ABHPs need to help their employees take a long-term view of these types of plans, beyond year one.

To aid their employees in making the transition to ABHPs, a majority of companies emphasize communication and education throughout the process. For example, 52% of employers offering ABHPs have implemented year-long communication strategies on the value and responsibilities of ABHPs. Another 20% plan to implement such communications strategies in 2015.

We’re still in the early stages of fitness wearables. For proof, look no further than the new wearables introduced at the Consumer Electronics Show (CES), the tech industry’s biggest trade show held every January in Las Vegas.

Put bluntly, as it was in a recent Bloomberg BusinessWeek article about two of the worst offenders: “The Smart Ring and the Smart Belt Are Actually Kind of Stupid.”

The so-called smart ring, called… wait for it… “Ring,” allows the wearer to turn lights on and off and open and close curtains with a flick of a finger. Kind of like Mary Poppins cleaning the childrens’ bedroom in the song, “A Spoonful of Sugar.”

Belty, the other wearable lampooned in the Bloomberg BusinessWeek article, is a belt that tightens and loosens depending on whether the wearer is sitting or standing. It also vibrates if the wearer has been sitting for too long.

While we might not rush to judgment that these products are “stupid,” they do reflect a basic theme of recent wearable unveilings: The technology is here; the utility, not so much. For those old enough to remember, or fans of old TV, just think the 1960s TV show “The Jetsons.”

For those unfamiliar with it, The Jetsons featured a decidedly-retro futuristic family: George and Jane, their children, Judy and Elmo, and of course, Astro, the family dog. The technology in the show is kitschy and entertaining — outlandish by design. Remember the auto-hygiene machines and treadmills floating in space?

But if fitness wearables are going to become widely accepted as key components of employer-sponsored wellness programs, they’re going to have to stay fun while getting a whole lot more functional. As we wrote in our previous posts on fitness apps and the challenge of pinning down ROI for wellness programs, there are still many obstacles to successfully implementing wellness programs and getting the most out of wearable health devices.

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Towers Watson announced today that Time Inc. has chosen Towers Watson’s OneExchange to deliver medical, prescription drug, dental, and vision benefits to its full-time active employees and their dependents for the 2015 plan year.

Time Inc. also added a new voluntary wellness program to give employees and dependents the opportunity to earn “well-being dollars.” Plan participants will have options in medical plans, as well as medical, dental, and vision insurers to choose from.

Said Jim Foreman, managing director, Exchange Solutions, Towers Watson, “Time Inc. is at the vanguard of a movement among the country’s leading employers to give their employees more choice and control over their health and wellness benefits. By using a private exchange to administer and deliver these benefits, Time Inc. is bringing the same spirit of innovation it demonstrates in its media business to helping its employees become better and more responsible consumers of health care.”

For the full release, click here.

Accountable Care Organizations (ACOs) have been making headlines as a relatively new option for reducing health care costs. ACOs do this by forming regional or local groups of medical providers — doctors, hospitals, clinics — who provide coordinated health care.

This coordination is designed to result in higher quality of care for patients by increasing communication between specialists, primary care providers, and other caregivers. It also can lower the cost of care by reducing duplicate tests and catching conditions early that, if left untreated, could develop into more costly chronic diseases.

As an incentive to form ACOs, the Centers for Medicare and Medicaid Services (CMS) shares the savings achieved for the Medicare program with ACOs that succeed in delivering high-quality care at a lower cost.

Since ACOs were authorized in 2010, nearly 400 have been formed. However, in the only analysis of results by CMS thus far, just 29 ACOs qualified for the bonus pay. Still, the payouts are impressive. As a chart published in CFO Magazine in December 2014 shows, the top bonus was $57.8 million with bonuses paid to the second- through fifteenth-ranked ACOs ranging from $39.6 million to $15.1 million.


These figures underscore both how difficult it is to improve health outcomes while reducing costs and the promise of ACOs as one method for doing so.

ACOs are not the only new policies Medicare has introduced to encourage coordinated care, however. In October 2014, Medicare introduced a policy that would reimburse doctors for providing coordinated care to Medicare-recipients with chronic conditions. In January 2015, the Obama administration announced its goals of having 30% of payments for traditional Medicare benefits tied to alternative payment models such as ACOs by the end of 2016 and 50% by the end of 2018.