With the end of the year just around the corner, we are taking a moment to look back at the most popular posts on the OneExchange blog this year.

Most-read topics included benefits administration, telemedicine, disease management programs, and types of benefits being offered, including student loan repayment, workplace perks such as snow days, and changing PTO policies. We also got to know more about exchange innovator Sherri Bockhorst, a managing director of Willis Towers Watson’s group exchange business.

Here are some interesting tidbits from the top 10 posts:

On workplace perks: “New parents no doubt perked up (pun intended) when companies offered such benefits as unlimited parental leave (Netflix) and $4,000 in “baby cash” for the birth of a newborn (Facebook).”

On telemedicine: “The average telemedicine visit costs between $40 and $49…. This compares favorably with a visit to a primary care doctor ($110) or a trip to the emergency room ($865).”

On biosimilars: “The potential benefit [from the FDA approving more biosimilars] is huge… biosimilars could result in over $44 billion in savings on biologics between 2014 and 2024.”

Read on for the complete list of the top 10 blog posts in 2016:

  1. “Panda Days” and Paid Time Off: What Perks Perk Up Employees
  1. Employers Look To Private Medicare Exchanges As Alternative To Group Retiree Health Coverage
  1. Meet Exchange Innovator Sherri Bockhorst
  1. Little Known Rule Allows Some Seniors To Change Medicare Advantage Plans When Plans Drop Their Doctors
  1. League Of California Cities Partners With OneExchange On New Private Exchange Offering
  1. Employers Add Student Loan Repayment To Benefits Offerings To Attract Millennials
  1. Employee Well-being In The Workplace A Priority For Employers In Coming Years
  1. More Private Exchanges Adding Disease Management Programs
  2. Reimbursement Issues Plague Biosimilars
  1. Telemedicine Benefits Remain Underutilized

In a twist on the famous lament of Kermit the Frog, it ain’t easy being an HR professional for a multi-state employer. Ok, so that isn’t as catchy as the original. But the reality is multi-state employers must address the varying state and local laws governing employee benefits and that can be complicated and time consuming.

Take paid sick leave, for example. In a recent article on the topic in Human Resource Executive, Jackie Reinberg, senior consultant for Willis Towers Watson, said, “The issues most employers are really struggling with is that systems are not easily adjusted for all of the different localities. A number of them are keeping spreadsheets because they just do not have the bandwidth right now to update all of the systems.”

This is especially challenging because some state and local laws include part-time workers, expanding the number of employees employers need to take into consideration when designing a paid sick leave policy.

To complicate matters even more, starting next year federal law will require employers who contract with the federal government to provide 7 days of paid sick leave. The clock is ticking for multi-state employers to comply with the law and make other modifications to their sick leave policies that are affected by it.

To read the article in Human Resource Executive, click here.

Willis Towers Watson this week released a list of the top 10 questions employees should ask their employers about 2017 plan offerings before selecting new plans or renewing existing ones. The questions are based the results of our 21st annual Best Practices in Health Care Employer Survey, which quizzed employers on their expected cost increases for 2017 and the actions they plan to take to manage costs while delivering quality care.

According to the survey, employers expect an average increase of 5.0% in total health care costs in 2017. Areas of focus for plan changes are prescription drugs, spouse and dependent coverage, and expensive medical procedures such as specialized surgeries.

In addition to questions about steps employers might have taken to keep costs down, we suggested that employees ask which health plans their preferred doctors and other providers accept; what new benefits–including voluntary benefits–employers might have added; and whether employers have introduced new technologies such as a private benefits exchange to help employees select and manage benefits.

For the complete list of 10 questions, read the press release here.

Despite efforts to establish quality metrics for health care and empowering health care consumers to choose elements of their own coverage, recent findings still show that people shop primarily around cost. This is according to an analysis by the U.S. Department of Health and Human Services (HHS), covered in a recent article in the New York Times.

According to the HHS analysis of buying trends in the public health insurance marketplace, two-thirds of people went for the lowest- or second-lowest-priced plans for the plan year 2015. For the plan year 2016, approximately half of people chose the cheapest plans.

According to health economist Austin Frakt in a different article in the New York Times, choosing a health plan based on premium price alone may be problematic because it leaves out other aspects of choosing care, such as the cost of the deductible. Other aspects of care, such as quality of care and number of doctors in the area, are also left out when only cost is considered.

This is where employers can step in. With clear and regular communication, and simple benefit tools, employers can help employees make the the best health care decisions possible given their health status and budgets.

To read the entire article in the New York Times, click here.

Employers are increasingly turning to private exchanges for their full-time employees, as evidenced by the recent announcement by Starbucks about making the switch.

While large employers have been slower to adopt private exchanges than small- to medium-size employers, according to Craig Jannino, group exchange leader for Willis Towers Watson, this has more to do the immaturity of early exchanges than it does with employer interest. In a recent article in Inside Health Insurance Exchanges, Jannino explained, “Large employers have not lost interest in exchanges. Instead, in our view, private exchanges have only recently evolved to meet the particular needs of large employers.”

Early adopters of exchanges were intrigued by the potential for cost savings. But large employers have traditionally done a good job of managing cost. Thus as exchanges have evolved, so have adopters. Instead of being primarily focused on cost, today’s adopters are also concerned about “meet[ing] the needs of a more multi-generational workforce, creat[ing] a more satisfying benefit experience, and manag[ing] the complexity associated with providing employees with a much broader array of benefit types,” said Jannino.

To read the entire article in Inside Health Insurance Exchanges, click here and select the August 2016 issue. [Note: Article is behind a paywall.]

In the (still) new world of the public exchanges, health plan consumers have been taking advantage of loopholes in the enrollment system, especially as it relates to special enrollment periods (SEPs).

The loopholes and how consumers exploit them are detailed in a recent article in Managed Healthcare Executive. According to the article, the public exchange “trusts but does not verify” claims that would result in an exemption. Some examples of claims people can make that render them exempt include:

  • Recently moved
  • Lost previous health coverage
  • Lost Medicaid eligibility
  • Had a change in family status (birth, marriage, etc.)

Jay Wolfson, a professor of public health, medicine, and pharmacy at the University of South Florida, explained two main types of people who falsely claim eligibility for the SEP: 1) people who cannot afford coverage and 2) those simply trying to game the system because they can.

Wolfson speculated that the former category exists because people can wait up to three months to pay for care, meaning they can rack up health expenses in that time and then cancel their coverage before they pay. According to Wolfson, it is unclear what motivates the latter category, Although it might have to do with resistance to the individual mandate.

Many health insurers have expressed concern about SEP system abuse. In comments submitted to CMS, the Blue Cross Blue Shield Association said, “Individuals enrolled through SEPs are utilizing up to 55% more services than their open enrollment counterparts, suggesting that SEP enrollees are sicker or waiting until they need care to enroll. SEP enrollees are also incurring costs in double digit magnitudes over the rest of the ACA risk pool.”

This cost gets spread over the risk pool, raising rates for everyone. That said, the article revealed that many are still optimistic that these loopholes will get closed and the issue will be resolved.

Interviewed for the article, John Barkett, director of policy affairs for Willis Towers Watson, said “In my opinion, plans are more likely to lobby public exchanges to change or enforce the rules than they are to pull out because of gaming. These are solvable problems for public exchanges, and CMS is already taking steps to resolve them.”

To read the complete article in Managed Healthcare Executive, click here.

According to new data from Willis Towers Watson, 56% of U.S. employers are confident that the public exchange will be “a viable option” for pre-65 retirees within the next two years. The data comes from the 2016 Willis Towers Watson Emerging Trends in Health Care Survey, which gathered responses from 467 employers representing 12.1 million employees.

Additionally, the survey found that 72% of employers intend to make moderate to significant changes to their existing pre-65 retiree health benefits. The willingness of employers to make these changes can be attributed to the continued rise in health care costs for this segment of the employee population. In other words, costs rise, and employers need to take action.

In a recent article for Business Insurance, John Barkett, senior director of policy affairs for Willis Towers Watson, said, “Employers are seeking alternatives to providing their retirees with the same group health care coverage they offer active employees. Many employers have already transitioned their post-65 retirees to original Medicare plus private individual Medicare plans or are planning to. This keeps costs down and retiree satisfaction up. However, because Medicare is not available to younger retirees, employers are looking elsewhere for a solution.”

To read the article in Business Insurance, click here.

To read the complete press release from Willis Towers Watson, click here.

A popular notion in some circles is that many people who purchase health insurance on public exchanges are unhappy or dissatisfied with their experiences. Three recent reports refute that contention: one from Deloitte, one from the Commonwealth Fund, and one from Kaiser Health News.

According to John Barkett, director of policy affairs for Willis Towers Watson, Deloitte has diligently followed the progress of public exchanges since they came online in 2014 and therefore, its study merits greater attention. The Deloitte report found that in 2016 53% of exchange consumers were satisfied with their health plans. This compares to 54% of consumers on employer-sponsored health plans.

Barkett shed more light on the implications of these findings. According to Barkett, critics knock public exchanges because they control cost through the use of narrow networks, which limits consumer choice. “This has been portrayed as a deal breaker for individuals who may have had the same primary care provider or health network for many years,” he said.

However, according to the Deloitte report, 27% of exchange consumers said they would take a narrower network in exchange for lower premiums. This compares to just 20% of health care consumers as a whole.

The takeaway, Barkett suggested, is that even with narrow networks, exchange consumers are satisfied with their options, on par with those of their counterparts who are ensured by their employers.

Furthermore, even when a narrow network required exchange consumers to give up their previous primary care provider, 74% still reported being satisfied with the primary care doctors and hospital networks included in their coverage, according to the Deloitte study.

The Commonwealth Fund and Kaiser Health News studies came to similar conclusions. The Commonwealth Fund study found that 44% of exchange participants were “very satisfied” with their coverage after the open enrollment period 2016, up from 40% in 2015. The Kaiser Family Foundation study found that two-thirds of marketplace consumers rated their coverage as either “good” or “excellent.”

Said Barkett, “It appears that reports of the death–or in this case, consumer dissatisfaction with plans on the public exchange–are greatly exaggerated.”

To read the Deloitte study, click here.

For the Commonwealth Fund study, click here.

For the study from Kaiser Health News, click here.

A growing number of health insurers are implementing so-called “narrow networks” of medical services providers to control costs. But while about half of all plans on public exchanges had narrow networks in 2014, it has taken longer for employers to embrace them. According to Trevis Parson, chief actuary of Health and Group Benefits for Willis Towers Watson, employers have been waiting to see evidence that narrow networks still deliver value in addition to lowering cost.

In a recent article in Business Insurance, Parson explained what motivates employers to consider narrow networks. “Really finding value is what employers are after,” he said. “That’s the fuel for these narrow networks on the large-employer group side.”

Narrow networks are networks that limit providers to those that have the best outcomes and lowest cost. While these types of networks in theory are what large employers seek, there are still too few of them to support a wholesale shift, said Parson. This is primarily because large employers need coverage across many states.

However, while Parson noted that early data on narrow networks is promising, “[Employers] want to see evidence before they act. The last thing they want to do is disrupt employees.”

For the complete article in Business Insurance, click here.

With the 2016 primary season coming to an end, and candidates at all levels turning their attention to the general election, the Affordable Care Act (ACA) will remain a topic of much debate. Some candidates want to see it repealed; others want to keep it and improve upon it.

But according to John Barkett, director of policy affairs for Willis Towers Watson, here’s something that all candidates might want to consider. While most employers had concerns about the ACA, six years have passed since the bill was signed into law. At this point, many employers are not willing to take the risk and endure the added disruption of throwing it out and starting all over again. However, they do want to see major changes to the ACA.

In a recent bylined article in Employee Benefit News (EBN), Barkett shared the five things employers would change about the ACA, based on his numerous conversations with employers about the good, the bad and the ugly of adapting to this major piece of legislation and the changes it has brought to employer-sponsored health care.

What would you change about the ACA?

To read Barkett’s article in EBN, click here.