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


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


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.


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.


In August 2016, Willis Towers Watson opened a state-of-the-art technology hub and service center in the greater Phoenix metropolitan area city of Tempe, AZ. The center is filling over 400 positions to work on software development and customer service for clients across the country. The number of employees there will increase to 800 over time.


800 New Tech Jobs Coming To Tempe [ABC Channel 12 News]

New hires in the center include software engineers, quality assurance specialists, product managers, licensed benefits advisors and customer service representatives, all serving employers and employees who use our private exchange solutions.

With the addition of the new center, our Exchange Solutions segment now has more than 5,000 employees in 12 U.S. development and service centers focused on developing and supporting technology-based employee benefit solutions.

According to Gene Wickes, managing director of Exchange Solutions for Willis Towers Watson, the center will help the company achieve three key goals:

  1. Accelerate the development of a consistent and seamless user experience across all exchange offerings by unifying development teams
  1. Accommodate staffing needs as Exchange Solutions scales to handle the high volume of phone calls during enrollment periods—already over 1 million and growing
  1. Continue the significant investments already made in the cutting-edge call center technology and training that continuously improve the efficiency of benefit advisors and customer service representatives


Learn more about the Phoenix tech hub and service center here and about our national centers 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.

LivingSocial, a company that provides a global marketplace for online deals on a variety of services and activities, has partnered with Willis Towers Watson’s OneExchange, a private health insurance exchange, to provide health benefits to its active employees. The company previously worked with another exchange vendor but “costly problems and rising employee dissatisfaction with benefits made a benefit program change an absolute necessity,” according to a company spokesperson.

“Because we’re a tech company with a workforce composed mostly of tech-savvy Millennials, it’s crucial to give our employees a consumer-grade experience via technically advanced tools,” said senior vice president of HR, Colleen Wood. “For us to retain the talent we need in today’s tech market, advanced technology is essential in everything we do. And how our benefit programs are perceived in the market affects our ability to evolve and thrive as a company. During our competitive search, it became clear that Willis Towers Watson and OneExchange were best equipped to meet our needs.”

LivingSocial self-identifies as a company in transition in the midst of considerable business upheaval, but senior director of operations David Chianese expressed confidence in OneExchange as “the partner that’ll help you navigate the ups and downs to get where you need to go.”

A comprehensive case study of LivingSocial’s decision to switch to OneExchange, as well as advice to other employers considering a private health insurance exchange for their active employees, is available on the Willis Towers Watson website by clicking 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.

While private exchanges often are touted for their potential cost-savings, choice is the key value that nearly three-fourths (72%) of U.S. employers highlighted in a recent Willis Towers Watson survey.

The 2016 Willis Towers Watson Emerging Trends in Health Care Survey surveyed 467 employers, representing 12.1 million employees, in January 2016. Moreover, post-enrollment surveys of employees using exchanges show that employees like to choose for themselves and are happy with the choices they’ve made.

According Sherri Bockhorst, managing director of group exchanges for Willis Towers Watson, choice does not mean leaving employees to fend for themselves. Said Bockhurst, “When choice is backed by advanced decision support and recommendations, exchanges help employees navigate complex options and make good decisions based on their needs. As a result, employees better understand their benefits and are able to derive more value from them.”

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

For an infographic on the survey results, click here.