December 26, 2016
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:
- Little Known Rule Allows Some Seniors To Change Medicare Advantage Plans When Plans Drop Their Doctors
A trend toward coinsurance over copays results in Medicare beneficiaries paying higher out-of-pocket prices for their prescription drugs. It also makes it harder for seniors to predict costs because drug prices fluctuate.
Unlike copays, which are flat rates, coinsurance rates are based on a percentage of total costs. Coinsurance was previously limited to higher cost specialty drugs, but its adoption in other drug tiers now is increasing.
According to an analysis from Avalere Health, reported in a recent article in Kaiser Health News, more than half (56%) of drugs covered under the Part D Medicare benefit will use a coinsurance model in 2016. Medicare Advantage plans are also making the change, but at a much lower pace. Just 26% of drugs offered through Medicare Advantage plans will require coinsurance in 2016.
Rising pharmacy costs have been a concern not just for seniors on Medicare, but for health care consumers and providers generally. Pharmacy Benefit Managers (PBMs) have been working to manage the rising cost of drugs to avoid passing on higher costs to employees.
It’s official. Over the next 2 years, CMS will be phasing in changes to how payments are calculated for group Medicare Advantage plans that provide health coverage to employers’ retirees. This is according to a recent ruling from the Centers for Medicare and Medicaid Services (CMS).
The changes are designed to stop substantial overpayments for providing Medicare-covered benefits. Even though CMS will require more competitive bids from employers and their carriers, the agency has said it also still expects the plans to offer comprehensive supplemental benefits.
John Barkett, senior director of policy affairs at Willis Towers Watson, was interviewed by Cort Olson for an article in Employee Benefit News (EBN) on this topic. According to Barkett, the changes have been a long time coming.
“MedPac has been pointing this out for a while, and this year in their annual rule making process, it was cited that employers are not competitively bidding for their Medicare payments,” said Barkett.
Barkett noted that employers were against the changes because they will negatively affect both employers and retirees. The only silver lining for employers is that CMS decided to phase the new rules in over two years rather than one year as was initially proposed.
(MedPAc stands for the Medicare Payment Advisory Commission, an independent U.S. federal body formed to advise Congress on the Administration of Medicare.)
For the complete article featuring John Barkett in EBN, click here.
For the complete article on the Medicare Advantage ruling, click here.
Little Known Rule Allows Some Seniors to Change Medicare Advantage Plans When Plans Drop Their Doctors
May 4, 2016
Medicare Advantage plans are an attractive alternative to original Medicare or original Medicare plus private supplemental Medicare plans for some seniors. However, Medicare Advantage plans have some limitations. While the plans can drop care providers and providers can drop out of plans anytime they want, in the past seniors were allowed to change plans just once a year, with some exceptions. This meant some seniors had to change doctors to continue receiving care.
However, in 2013, the Centers for Medicare and Medicaid Services (CMS) issued rules giving Medicare Advantage plan members a “special enrollment period” based on what the CMS called a “significant” change in their provider networks. The rules went into effect last year and so far, CMS has allowed more than 15,000 people to change plans based on changes in their providers.
But two obstacles stand in the way of more seniors taking advantage of the option. First, CMS is not publicizing the benefit, so many members don’t know about it. Second, CMS has not clarified what it means by a “significant” change.
In a recent article in Kaiser Health News, Medicare Deputy Administrator Sean Cavanaugh offered an explanation for what CMS looks for in granting special enrollment periods: “What we’re looking for is whether their selection of a plan was based on a network and the presence of certain physicians and that their [the plan member’s] selection would’ve been different.”
Cavanaugh further advised members to call CMS’ help line, 800-Medicare, to request permission to leave their plans because they lost their doctors. But he cautioned that members are being allowed to switch plans only “in rare situations.”
Still, for employers with retirees who currently have Medicare Advantage plans or are considering one, the new rule is important to know about: it could provide a pathway for retirees to maintain their long-standing relationships with their care providers.
To read the complete article in Kaiser Health News, click here.
February 23, 2016
I’m Sherri Bockhorst, managing director with Exchange Solutions, Willis Towers Watson’s private exchange business segment.
It’s my mission to support employers’ strategic business needs as well as help them meet their employees’ needs around their health care, finances and family situations.
At the end of the day, I’ve found that employers and employees are after the same thing: They want better health, productivity and protection from risk.
I help support the strategic direction of our group exchange for active employees through product design and development, forming strategic alliances with value-add third parties and raising the level of awareness and understanding across exchange-space participants including employers, employees, insurance carriers, and others.
My health insurance roots
Most of my career has been focused on supporting large employers in the health care space. I have worked with employers under many different circumstances, including companies that needed to figure out how to provide benefits in a high-turnover environment, or how to work successfully with their unions.
My passion for my current job is based on seeing how a comprehensive exchange solution can be configured to solve each employers’ unique needs in a way that provides many options for the employer and a range of plan choices to meet the diverse needs of employees.
Exchanges like ours take the best practices that we’re figured out for large employers with the resources for a completely custom solution and package those leading-edge solutions so employers without the same resources can deploy a similarly configured approach.
We take the best thinking from our years of experience working with large employers – levers like high-performing networks, optimizing pharmacy costs, promoting and supporting consumerism, choice from the right mix of plans so employees and retirees can pick the best one for their personal needs, and integrated well-being and incentive design – and make it more accessible to smaller groups. Because why should these levers only be available to employers with a 100,000-employee workforce? The same solution could make sense for employers of any size.
At the same time, many employers aren’t necessarily ready to adopt the full depth of our solution. Account-based health plans are a good example; initially employers may want to make them available while continuing to offer more traditional options, like PPOs. Not all employers will be on a total replacement track, but having access to them is likely to be of interest.
All of those levers are embedded into OneExchange. So if and when employers are ready to change gears and adopt new strategies to achieve their goals, they can dial our exchange levers up or down at the pace that’s right for their organization.
Where I see health insurance going
Right now we’re continuing to see exchanges evolve and change, and that makes a lot of sense, given how this space is developing as a new way for employers to deliver health benefits.
With employer adoption, we’re learning more about what employees will purchase, what kinds of choices and products they gravitate toward and how much they need to talk to individuals or want other types of on-demand decision support.
So that brings us back to where we started in terms of employers and employees ultimately wanting the same thing. Exchanges are fine-tuning the many ways their offerings can support the common ground between employers’ and employees’ goals – both where they are now and where they want to be over time.
As exchanges become more ubiquitous – and I believe this will happen within the span of my career – private exchanges will contribute greatly to the environment that will create transparency and choice for individuals and operate as a robust channel for delivering higher value employee benefits programs for employers.
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.
September 24, 2015
Cobb County in Georgia and the Alameda County Employees’ Retirement Association (ACERA) in California are public retirement systems that sought new ways to provide affordable, comprehensive health plans for their retirees in the face of high costs and growing concerns over the long-term liability of offering the benefit. Both turned to Towers Watson’s OneExchange for a Medicare solution.
OneExchange helped in several ways, including by offering a wide variety of plan options, providing one-on-one enrollment support to retirees, and delivering a suite of communication tools to educate retirees.
In fact, well-thought-out plans for communicating to retirees were a common theme in the success of both organizations. Communications are a key success factor for all employers transitioning retirees to a private Medicare exchange, regardless of whether they are public sector organizations or private companies.
Among the best practices for communications cited by the two counties include:
- Educate staff. Medicare exchanges offer individual Medicare supplemental and Medicare Advantage plans, and most retirees are used to traditional group health plans. Staff must be equipped to help retirees understand the differences and what it means to them.
- Prepare retirees. In addition to getting information on how the Medicare plans offered will change, retirees need specifics on how to enroll, where they can get help with decision-making and the timeline for the transition.
- Allow plenty of time. Retirees might be geographically dispersed and some might not use email. Because most communication will go through regular mail, employers need to leave enough time in their transition plan to ensure that everyone is ready by the start of the enrollment period.
- Leverage existing tools. Existing communications formats such as company newsletters or customized mailers have the added benefit of being familiar to retirees.
Although these suggestions are broadly applicable, it also is important to develop communication strategies that take into account the specific attributes of the region, industry, and organization.
To learn more about Cobb County and ACERA’s private Medicare exchange transitions, see the case study in Governing magazine.
April 12, 2015
This post is part of our Exchange Innovator Series featuring leading private exchange, health care reform and Medicare experts from Towers Watson.
I’m Joe Murad, managing director with Exchange Solutions for Towers Watson. I oversee our individual exchange solutions that serve Medicare-eligible and pre-65 retirees, part-time employees and their families.
Every day, my goal is to figure out how we can leverage our position as a technology leader to connect employers and the consumers they represent with better value while selecting health insurance. Our mission is to create cost savings for our employer-clients and provide our individual consumers with improved choice and control over their health benefits.
My health insurance roots
I grew up in Silicon Valley, surrounded by technology, innovation and disruptive market forces. Of the four start-ups I’m fortunate to have been a part of – my last two have been in the health insurance space – but I got my start in the world of relational databases.
It’s very typical of Valley ventures that innovation comes from outside an industry – from those who are not entrenched in industry thinking. Given my tech and my health insurance experience, I’m now one of the few people in our industry who has brought technological advancements to health care twice.
I helped found the nation’s first private Medicare exchange start-up a decade ago. Today I continue to apply that expertise to help employers leverage opportunities in the individual market made possible by health care reform.
It was true then and remains true today that health insurance – the largest sector of the nation’s largest industry (health care) – is burdened by inefficiencies, making it ripe for innovation and change.
The evolution of private exchanges
Private exchanges emerged as a result of three factors coming together at just the right time. The first was the idea of managed competition in health care, pioneered by Alain Enthoven in the 1970s. We were very fortunate to work closely with Alain early on as we were designing our private Medicare exchange.
The second factor was health care reform – which took the form of the Medicare Modernization Act in 2003 and now the Patient Protection and Affordable Care Act (PPACA, aka the ACA) of 2010 – both of which created a viable individual market for health insurance, first in the Medicare world and now in the pre-65 world.
The third factor is powerful platforms for consumer technology, which emerged in other industries – think of Amazon and Travelocity – and which we applied to health insurance.
Today my focus is on helping employers provide quality health benefits at a lower cost and to empower consumers with more choice and control over their health benefits. I also believe that over time our exchange model will drive more consumerism in health care – which will lead to a more efficient and effective health care industry.
Where I see health insurance going
On the Medicare exchange side, the market has hit its stride in the private sector. Two years ago when IBM announced moving to OneExchange for its retirees, the whole nation sat up and took notice of the exchange concept. It was no longer seen as a nascent technology play – it’s now understood as a practicable strategy that crosses all industries and company sizes. We are also seeing strong uptake in the traditionally conservative public sector.
As we move forward, the next logical frontier is how to make health insurance more reflective of the voluntary insurance and employment markets, which have become more personalized and portable in recent years.
If you think about all the other insurance coverage people have access to – auto, home, life – and combine that with the leading retirement savings programs – 401ks and IRAs – these are portable, individual plans and accounts that aren’t tied to where someone works. Why should health insurance be any different?
In the past, because employers were the purchasers of health insurance, they made all the decisions. With exchange technology enabling employers to offer retirees and employees more choice and control of their own health coverage decisions, it raises the question: Why can’t employees take the coverage they’ve chose for themselves when they move to another job? The law isn’t there yet but the consumer mindset is. If health reform catches up to that thinking, we will be there to provide the business model and technical solutions to enable it.
April 10, 2014
Wellness data is very “in” these days. Wearable technology such as FitBit allows individuals to track their fitness activity and apps let people track calorie consumption or weight loss.
The recent data released on Medicare doctor pay has unleashed a firestorm of controversy because of the amount of money some doctors made from treating Medicare patients — as much as $21 million in the case of one opthamologist. The Centers for Medicare and Medicaid Services released the data this week, for the first time in 35 years. The data had been held subject to the resolution of an injunction, sought by the American Medical Association, which had been in place since 1979.
But it’s not all bad news. Think of this as another kind of wellness data. Essentially it is wellness data, a level up — data on the “wellness” not of the individual, but of the Medicare system as a whole.
The specific dollar amounts will be repeated and repeated as evidence of excess and even criminal activity on the part of some doctors. But the longer term takeaway is that data facilitates transparency. [To see exactly what reimbursements were state by state, check out this interactive map from USA Today.]
“Taxpayers have the right to understand what is being paid for and how it is being paid for,” said Jonathan Blum, principal deputy administrator for the Centers for Medicare & Medicare Services.
In addition to it being a taxpayers’ “right,” having this full data transparency allows Medicare administrators to identify areas of excess and inefficiency and consumers to compare prices. It also allows all of us to consider broader questions about health care in the United States, for example, why some surgeries are performed more or cost more in one geographic area as opposed to another.
Shining the light on this data opens up the Medicare program to be improved, streamlined and hopefully, made sustainable for generations to come.
February 7, 2014
>> Stay tuned later this week when the Extend Health blog gets a new name and look. <<
The recent expansion of our Exchange Solutions business segment is a good opportunity to look back at the news from our private Medicare exchange over the past few years. Here are highlights from our early days to today.
Exchange Solutions Survey: Retirees Embrace Exchanges, Still Rely on Help From Benefit Advisors To Make Purchase Decisions
August 7, 2013
We’ve heard a lot about exchanges in the media, especially as the implementation date approaches for the first wave of the Affordable Care Act (ACA). With phrases like “public exchanges” and “online marketplaces” making headlines, it raises the question – what are exchanges and how do they work?
One group of people that knows is the Medicare-eligible retirees who have purchased individual private Medicare plans on our exchange. In a survey of 567 of our retirees fielded between July 27-July 29, 2013, respondents demonstrated a clear understanding of exchanges, with 46.4 percent identifying them as “a marketplace that makes it easier to compare healthcare plans from different health insurance companies.” Just 12.4 percent responded, “I don’t know.”
Based on their experience with our private exchange solution, 52.3 percent of retirees said they consider “exchanges a welcome addition to the U.S. health insurance system.” Just under a quarter (23.5%) even said, “I wish my employer had allowed me to select and enroll in health insurance plans through an exchange when I was an active employee.”
Our retirees also reported that they are using web-based decision support tools when evaluating and comparing health insurance plans. While our retirees historically preferred talking with benefit advisors over the phone to evaluate plans on exchange – and that has not changed – a large number of respondents to our recent survey said they also compared different plans using the exchange website (47.8 percent).
When it comes to purchasing a plan, however, just 8 percent said they purchased online on their own, with no help from a benefit advisor. This reinforces our long-held belief that while technology powers health insurance exchanges – and helps people compare plans, make purchase decisions and enroll in plans – technology is no substitute for direct human interaction.
As we’ve said many times before, an exchange is more than an interactive website.
Details on survey questions and answers follow.
Which statement best describes a health insurance exchange?
A marketplace that makes it easier to compare
health plans from different health insurance companies
A marketplace that promotes competition between
health insurance companies that results in lower
A marketplace where buyers have more choice
in health plans
An organized marketplace for buying and selling
I don’t know
Based on what you know about health insurance exchanges, which of the following statements are true? (Please select all that apply.)
Health insurance exchanges are a welcome
addition to the U.S. health insurance system
I prefer to purchase my private Medicare plans
through an exchange
Everyone should have access to a health
I wish my employer had allowed me to select
and enroll in health insurance plans through
an when I was an active employee
Health insurance exchanges are unnecessarily
adding little or nothing of value to our
health insurance system
When you evaluated or purchased a health plan on an exchange, which of the following types of support did you use before making your purchase? (Please select all that apply.)
Talked on the telephone with a benefit advisor
Compared different plans using the exchange
Reviewed ratings of health insurance plans and
Talked with family members or friends
Read articles, blogs or forums online
When you evaluated or purchased health insurance plans on an exchange, did you:
Evaluate and purchase plans only with
the help of a benefit advisor
Evaluate and purchase plans online by
yourself with no help from a benefit advisor
A combination of the two