robharkins

For highlights of my perspective in articles and blogs, see my comments on LinkedIn and Twitter.

This post is part of our Exchange Innovator Series featuring leading private exchange, health care reform and Medicare experts from Willis Towers Watson. See John Barkett and Sherri Bockhorst.

I’m Rob Harkins, private exchange practice leader for mid-market employers, for Willis Towers Watson’s private exchange business sector.

As part of the Health and Benefits segment, it’s my mission to ensure satisfaction internally, as well as externally, with our leading mid-market clients, accessing a modernized technological approach to benefit delivery, whether their need is individual Medicare, pre-65 retiree benefits, or group coverage.

I’ve been heavily involved during the merger of Willis and Towers Watson, enhancing the transition and acting as a bridge between our Health & Benefits consulting group and our base of mid-market employers, with populations ranging from the hundreds to the tens of thousands.

My health insurance roots

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Baltimore with my wife and friends

I cut my teeth on exchanges at Extend Health – a start-up that was acquired by Towers Watson in 2012. Having worked on Medicare Advantage with a focus on state and public sector employers, I was a steward for our channel partner relationships between consultants that wanted to provide a private Medicare exchange to their clients, including Towers Watson and Willis. I eventually moved from Extend Health to become the exchange practice leader at Willis. Collaborating with Liazon, I developed the Willis private exchange platform. In the process, I kicked the tires on every private exchange in the market in order to create something that would deliver true value to our employer clients and their employees.My education was in health care administration, which provided a terrific springboard for my career. I’ve worked in a range of companies, from start-ups to major national health insurance carriers, and this breadth of experience helped me to develop products and solutions that synched with innovation in the health care space.

 

My attention and focus is always drawn to what we can do operationally to innovate with technology and engage employees. I’ve always been the change agent. My true passion is looking at what is on the horizon and integrating the very best components of the past, present and the future into one integrated vision. One of my strengths is getting employers to understand how and when change can be beneficial. I believe in identifying various opportunities that can bring clients value, and then helping them get there by painting that picture for them.

Where I see health insurance going

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I love the outdoors and hiking

One of the top reasons employers are now turning to private exchanges is the changing workforce.

A digitally savvy younger workforce does not want to access benefits from an antiquated system. They just don’t. No one wants to get into a car and wind down a window or push a button to lock a door. Health exchanges are to benefit delivery what the smartphone has been to the telephone.

The benefits world moves very slowly, especially when it comes to employers who have a very paternalistic approach to employees. But how can we continue to deliver on paper or in a clunky benefit administration system that has to rival the ease with which we can buy cars? The system has to be very sophisticated.

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Very proud of my big family

Private exchanges are bringing benefits into the 21st century—with access and choice. Ten years from now, everyone will be using exchanges, because the way it was done yesterday just can’t continue. Once you change technology, there’s no going back. The dial-up phone is gone.

I believe that there will be gradual embracing of all the components that are part and parcel of the technology enhancements exchanges bring.

We all learned how to shop online—no one gave us a training manual. We all figured it out, and our culture changed around the technology, and the technology was very agile and responsive. And that’s what the exchange platform is: It’s a new way of doing things.

To reach me for comment on an article or a presentation, contact Melanie Meharchand, Director of PR and Social Media for Exchange Solutions, Willis Towers Watson.

 

According to Kaiser Family Foundation data, just 23% of employers with over 200 employees offered retiree health benefits last year. But that statistic doesn’t tell the whole story.

Rather than exiting retiree benefits, a growing number of employers are looking to other avenues to provide benefits to retirees, including private Medicare exchanges.

According to John Barkett, director of policy affairs for Willis Towers Watson, the private exchange option is appealing to employers for a variety of reasons. In a recent article for Business Insurance Barkett said, “[A private Medicare exchange] allows employers to make coverage available with predictable costs and in an affordable way.”

Barkett noted that an exchange also allows employers to offset the cost of the benefit for both themselves and retirees by creating and making contributions to tax-advantaged health reimbursement accounts (HRAs) on behalf of retirees.

While traditional employer-sponsored retiree health coverage continues to decline, data from Willis Towers Watson shows that this alternate approach is on the rise. One third of U.S. employers surveyed by Willis Towers Watson reported that they have already transitioned to a private Medicare exchange for retiree benefits and two-thirds are considering it by 2018.

For the complete article in Business Insurance, click here.

Health care costs continue to rise, spurred to new heights by the exponential increase in the cost of specialty pharmacy, among other things. According to the Willis Towers Watson/NBGH Best Practices in Health Care Employer Survey, employers expected a 4.1% rate of increase in the cost of employer-sponsored health care benefits in 2015 — the lowest in 15 years but still well above inflation.

Employers, insurers, and health care providers are all looking for new strategies to manage the rising cost of health care in 2016. Shelby Livingston covered this in a recent article for Business insurance, and spoke to Sandy Ageloff, west coast leader of Willis Towers Watson’s Health & Benefits Practice.

Employers focus on several common themes to control cost, including managing the rising cost of pharmacy, adopting high deductible health plans, and increasing adoption of health reimbursement accounts (HRAs).

One area of focus within the overall pharmacy spend is the rising cost of specialty pharmacy. “Pharmacy is the component of employee benefit plans that has the highest rate of increase right now,” said Ageloff.

For more information on the rising cost of specialty pharma specifically, see this recent Willis Towers Watson press release.

For read the complete Business Insurance article, click here.

Towers Watson has unveiled a new personalized decision support service that will help pre-Medicare retirees determine whether they are better off using a subsidy from their former employer or taking a tax credit from the federal government. Under the Patient Protection and Affordable Care Act, pre-Medicare retirees can use either a tax-advantaged employer subsidy or a federal tax credit to defray the cost of their health insurance premiums — but not both. The service is designed to help early retirees optimize their health insurance spending without “double dipping.”

Employer clients of Towers Watson’s OneExchange requested the service to make it easier for their early retirees to evaluate and enroll in health plans on the individual market. Retirees can take advantage of the service by phone through a OneExchange benefit advisor or go online and access a guided self-service tool at no charge.

For employers offering subsidies, Towers Watson will create and manage health reimbursement arrangements (HRAs) for their early retirees. Early retirees accepting employers’ funding have the option of buying individual plans directly from insurers or from public exchanges. Early retirees who accept a tax credit must choose plans from the public exchanges.

For more information about the new service, click here for the full release.

Extend Health exhibited at the Garland Senior Fair in Texas this past Sat, Aug 4. There was a great turnout of over 350 people from the community and surrounding areas including seniors, their families, community leaders and service providers like us, who care about seniors and senior issues.

State Representative Angie Chen Button thanked Dwight and Ivory in person for exhibiting at the fair, fulfilling an invitation that she extended to Bryce Williams, Towers Watson Managing Director of Extend Health, at the ribbon-cutting of the first Extend Health service center in Richardson this past May.

Richardson Mayor Bob Townsend encouraged everyone to make good use of the resources available. And many other community leaders, including City of Rowlett Senior Advisory Board members Pamela Bell and Wayne Baxter, met with attendees and the community groups and companies exhibiting.

Dwight Turner and Ivory Rooks, both senior benefit advisors for Extend Health, who have years of experience helping seniors choose the best Medicare plans for them, served as Extend Health ambassadors. They answered people’s questions about Medicare and shared resources with them, explaining the role Extend Health can play in helping to connect people with the best coverage for their needs.

According to Dwight, “We put the care into shopping for Medicare!“

Ivory added, “It was great to be able to connect in person with people and extend a helping hand.”

Extend Health contributed a Texas-themed gift basket, which was raffled off to a lucky winner. The day was welcome chance to connect in person with many in a community that is very important to Extend Health.

We recently announced that Extend Health is bringing over 500 jobs to the community with the opening of its second service center in the Richardson Telecom Corridor.

Visit Extend Health to use the ExtendExchange™ platform – the nation’s largest private Medicare insurance exchange.

If you’re evaluating a Medicare exchange solution for your retirees, you may be wondering how much time the transition will take so you can figure out when to get started. After five years of experience at Extend Health, we have developed a process and a recommended timeline that works. If you are planning to move your retirees to coincide with the change to the RDS taxable status, this article will help you understand what you need to do to make the transition before the change takes place on January 1, 2013.

The actual start date for the process is determined by the start date for new insurance benefits. Employers can choose any start date they wish. In an ideal world the process would take place over a five to six month period, divided into four phases as follows, with key milestones in place during each phase:

  • Planning: Starts four to five months before enrollment begins (seven to nine months before new coverage start date) and lasts six-eight weeks
  • Retiree Education: Starts 45 days before enrollment begins and lasts six to seven weeks
  • Enrollment: Starts 90 days before start of new coverage. Employers have the option of designating the dates or length of time during which they want enrollment to take place; we recommend allowing four to six weeks.
  • Post Enrollment: The employer’s responsibilities during this phase are minimal. Extend Health takes over all administrative tasks for the newly-enrolled retirees.

Phase One: Planning

Ideally, this phase takes place four or five months before enrollment begins. Once the decision to move forward has been made, there are a number of key elements that need to be put in place before announcing the change, including:

  1. Employer and Extend Health team meet to plan transition
  2. Do data analysis to determine retiree HRA funding amounts
  3. Write and distribute employer announcement of benefits change

Phase Two: Retiree Education

This phase, which starts 45 days prior to enrollment, is focused on making sure retirees understand the changes to their benefits and the process for enrolling new coverage. During this phase:

  1. Getting Started Guide, first Extend Health mailing, delivered to retirees. Includes welcome letter, FAQ, and workbook to assist in creating profile
  2. Retirees create profile either on-line or on the phone with a benefit advisor
  3. Retirees schedule enrollment appointments
  4. Retiree on-site meetings take place

Phase Three: Enrollment

The start date of the enrollment phase is calculated by looking at the start date for new coverage and counting back 90 days. The employer can choose any start date it likes. For example, if an employer wants new coverage to start on June 1, then enrollment should begin on March 1. This allows time for insurance carriers to process the new applications and mail insurance cards to retirees in time for the start of coverage. During this phase:

  1. Retirees receive the Extend Health Enrollment Guide, including Medicare basics plan education, what to expect on the enrollment call, and appointment confirmation.
  2. Enrollment calls take place.
  3. Extend Health delivers reminder post cards and (if necessary) certified mail to those retirees who do not respond in a timely manner.

Phase Four: Post-Enrollment

The employer’s role is minimal during the post-enrollment phase. Retirees often have questions during this phase but Extend Health has a team of benefit advisors and customer service representatives who will help them with carrier or HRA issues, or any future changes to their medical and prescription drug requirements. During this phase:

  1. Extend Health delivers plan selection confirmation letter
  2. Insurance carriers send out welcome guides and new insurance cards
  3. Extend Health delivers a welcome letter and the HRA packet

Example timeline

If an employer wants new retiree benefits to start on September 1st, the timeline for a smooth transition would look something like this:

  • Phase 1 planning begins between February 15 and February 28
  • Phase 2 retiree education begins April 15
  • Phase 3 enrollment begins June 1
  • Phase 4 post-enrollment begins with the start of new coverage on September 1

Visit Extend Health to use the ExtendExchange™ platform – the nation’s largest private Medicare exchange.

Happy Holidays!

December 23, 2011

Happy Holidays to all our readers. Thank you for your support in 2011.
We’ll be away for the next week, but we look forward to seeing you back here
for an exciting 2012 . . . there’s sure to be much to write about!

Washington Extension

October 7, 2011

Medicare News

Researchers at the Harvard School of Public Health found that among Medicare beneficiaries in their last year of life in 2008, one-third had a surgical procedure performed. One-fifth had surgery in the last month of life, and one in ten had surgery in the last week of life. The rates of surgery varied dramatically across the country, but geographic variation is controversial because it is unclear whether it reflects unnecessary care or true differences in patient needs. This report adds to the influential research conducted by the Dartmouth Atlas of Health Care showing Medicare beneficiaries living in areas of the country with lower intensity of end-of-life care do not have higher mortality rates.

The Michigan state legislature voted to end retiree health benefits for future and newer sitting legislators, in the face of state budget shortfalls. Retiree health benefits cost the state about $5 million in the last fiscal year. Governor Rick Snyder has promised to sign the legislation.

ACA Updates

The Institute of Medicine (IOM) released its highly-anticipated report on the criteria for determining essential health benefits (EHB) that ACA-qualified health plans must cover. The ACA defined ten categories of commonly-covered health services that plan benefits must include. The IOM identifies criteria for defining and updating specific components of the EHB, including: use a public deliberation process, include only medically necessary services that are value-based, promote some state flexibility, make annual updates based on credible evidence of effectiveness of benefits, and rely on typical coverage in the small employer market. Unlike Medicare’s coverage standard of “reasonable and necessary”, the IOM recommends higher standards for benefit coverage, such as the treatment demonstrate meaningful improvement over current effective services/treatments, and is cost effective. These criteria (among others) are aligned with the criterion that the EHB package, in aggregate, be affordable.

In ongoing litigation regarding the ACA, 26 states and the NFIB filed petitions to the Supreme Court to appeal the ruling in the Eleventh Circuit which struck down the individual mandate but upheld the remainder of the ACA. The Department of Justice also filed its own petition requesting review of the Circuit Court decision, significantly increasing the odds that this issue will appear on the Supreme Court’s docket this term (though the Court may have more than one case to choose from). Outstanding questions remain about the ability of the Court to rule on a federal tax law before anyone has actually paid the tax (i.e. the individual mandate penalty).

Nebraska will wait until the Supreme Court decides on the constitutionality of the ACA before setting up a health insurance exchange. According to the governor, the state is designing a program and applying for federal funding, but won’t build a “formal proposal” until the Court decides. Minnesota’s prospects are less clear: while the governor has secured millions of federal dollars, and has support to design a state-run exchange from the Minnesota Chamber of Commerce and some Republicans in the legislature, a debate rages about whether the governor needs authorization from the GOP-controlled legislature—which has been unwilling to pass a bill—to set up an exchange.

On the Hill

House Republicans released their 2012 draft budget for health, labor and education, totaling $153.4 billion. This compares with the Senate Democrats’ proposed budget of $165.3 billion. The Republicans’ draft bill prohibits funds to implement the ACA, as well as provisions to rescind funding already provided for ACA programs. Rep. Denny Rehberg (R-MT), chairman of the House Appropriations Labor-Health and Human Services subcommittee, recently wrote to the “Super Committee” recommending they cut ACA Medicaid expansions and affordability credits to achieve their $1.2 trillion deficit reduction goal.

Reports/Other News

About one quarter of retirees think that life in retirement is worse than before they retired, according to a RWJF/NPR/Harvard School of Public Health poll. This compares with only 14% of pre-retirees who expect that retired life will be worse. Retirees cite costs of medical treatment and long-term care as especially worrisome. Many fewer pre-retirees think that their health will be worse (13%) during retirement than retirees who say their health actually is worse (39%). Pre-retirees are also less confident (38%) that Medicare will provide benefits of at least equal value to current benefits than retirees (52%).

Average annual premiums for employer-sponsored health insurance in 2011 rose 8% for single coverage (to $5,249) and 9% for family coverage (to $15,073) over 2010 costs, according to this year’s Kaiser Family Foundation/HRET employer health benefits survey. The percentage of total premium paid by workers is similar to 2010 (18% for individuals, 28% for family coverage). Among firms offering coverage to employees, 26% offer retiree coverage, similar to 2010. State and local governments are most likely to offer retiree health benefits (83%), while large firms in the retail and wholesale industries are least likely (15% and 16%). Nearly all (91%) of offering large firms cover early retirees below age 65, while 71% cover Medicare-age retirees. AHIP blames rising insurance costs on prices for medical services, asserting that Washington must do more to control cost growth. Kaiser attributed 1-2% of the premium increase to provisions of the Affordable Care Act, including allowing children up to age 26 on their parents’ health insurance.

The Government Accountability Office (GAO) released a report showing 170,000 Medicare Part D beneficiaries received prescriptions for controlled substances from five or more physicians in 2008, indicating fraud and prescription drug abuse in Part D. In ten individual cases examined by the GAO, physicians did not know that their patients were receiving drugs prescribed by other physicians. Although Part D plans are required to perform retrospective drug utilization reviews to identify inappropriate or unnecessary medication use, plans are not authorized to restrict drug access based on the findings.

Visit Extend Health — the nation’s largest private Medicare exchange.

The Washington Extension

September 23, 2011

Medicare News

The Obama Administration has recommended $320 billion in cuts to health care programs (pdf, p.35). The Medicare program is implicated by the following major policy proposals, almost all of which have been previously proposed and are roundly criticized by industry and consumer groups:

  • Impose a Part B premium surcharge equal to about 15% of Medigap premiums for new beneficiaries who purchase Medigap policies with “particularly low cost-sharing requirements”, starting in 2017
  • Impose $100 copayments for home health services (currently there is $0 copayment)
  • Increase the Part B deductible faster than currently projected
  • Increase the premiums that high-income Medicare beneficiaries pay
  • Drug companies pay rebates for drugs sold through Medicare Part D to low-income patients, similar to the current Medicaid rebate program
  • Cut funding from the public health fund created by the Affordable Care Act

As Extend Health has noted elsewhere, the Healthcare Leadership Council—comprised of health care industry leaders such as Pfizer, Aetna and the Mayo Clinic—proposed $410 billion in deficit reductions that they claim would also increase Medicare’s long-term solvency. The Medicare proposals include creating a “Medicare Exchange” where seniors can choose among private plans, increase the Medicare eligibility age to 67 from 65, cap annual out-of-pocket costs, and dramatically increase Medicare premiums for higher-income beneficiaries.

ACA Updates

The Federal government is increasingly looking to offer states options to share the responsibility of creating and running health insurance exchanges. The Center for Consumer Information and Insurance Oversight at Health and Human Services is proposing three options, including: 1) states managing health plan participation, 2) helping consumers navigate the system, or 3) both. Any of these options would leave the eligibility and enrollment processes to the Federal government.

New York State’s Republican-led Senate is blocking efforts by the state to pass a bill establishing a health insurance exchange. New York already received $39 million to begin establishing an exchange, but the Republicans’ refusal to take up the bill negotiated by lawmakers and Governor Cuomo is obstructing the state’s ability to seek additional Federal financing.

Michigan’s Republican governor, Rick Snyder, has recommended that the legislature pass a bill creating a non-profit health insurance exchange called MIHealth Marketplace. The exchange would be governed by a Board appointed by the governor, with an advisory panel comprised of representatives from small business, consumers, insurance plans, providers, agents and others.

The Blue Cross Blue Shield Association (BCBSA) is criticizing the Obama Administration for releasing regulations too slowly, and being too vague in those that are released. In particular, BCBSA alleges that the health insurance exchange regulations don’t have enough information about how the marketplaces will function, what will be the minimum requirements for plans in the exchanges, and the lack of information about selling insurance outside of exchanges.

Reports/Other News

A Mercer study finds that premiums for employer-based insurance coverage will rise 5.4% in 2012, the lowest growth in fifteen years. Survey respondents attribute this low growth to less utilization, due to a slow economy and cost-cutting benefit changes such as higher deductibles or cost sharing.

The National Council on Aging and UnitedHealthcare find that fewer than half of seniors understand Medicare well, and half describe their understanding of the Affordable Care Act as “poor”. Even among widely advertised ACA reforms, there is little understanding: less than 1/3 of seniors are aware that they will pay a discounted amount in the Part D ‘donut hole’. Finally, just over half of seniors say they have excellent or good knowledge about evaluating their Medicare options.

Visit Extend Health — the nation’s largest private Medicare exchange.

Extend Health CEO Bryce Williams has written a new piece just published on the Society for Human Resource Management Web site. Bryce is known around here not only for his deep knowledge of health care insurance, but for constantly thinking about ways we can empower employers to provide affordable health care benefits to their employees. This new article offers some sage advice for employers who want to continue to offer early retiree benefits but need to control their costs. The key? Start moving them to defined contribution plans now:

“Until 2014, can early retirees be helped? The answer is yes: by beginning to move them from legacy group plans to ‘defined contribution health plans’ and providing education and tools, HR managers can empower their early retirees to become cost-conscious and careful consumers, changing their mindset from ‘I don’t know how much my health benefits cost and I don’t care’ to ‘I know how much my health benefits costs and I do care.'”

The article outlines a roadmap for supporting early retirees through the transition from group plans to individual plans purchased on the coming state insurance exchanges, with advice for the kind of programs and education that will help this vulnerable population become “empowered individual health insurance consumers” — while at the same time giving employers the ability to plan, predict, and control costs.