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

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.

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.

Enrollees in health plans on public exchanges are “underreporting” that they are smokers to avoid a tobacco surcharge being levied on their plans. This is bad news for all public exchange participants, including non-smokers. The tobacco surcharge–estimated to be 10% on average in 2014–is meant to offset the high cost of diseases associated with smoking such as lung cancer.

Unfortunately, the current system does not have the ability to verify if someone who claims to be a non-smoker is telling the truth. Said Jeff Levin-Scherz, senior consultant for Willis Towers Watson, “Enforcement typically relies on the honor system.”

The same is true for employer-sponsored insurance as well, although not all companies rely exclusively on the honor system. According to Levin-Scherz, some companies require lab tests for employees, which can help them identify smokers. In 2015, about 40% of large employers had a tobacco surcharge.

Even when smokers do self-report, it’s not clear that the surcharges are effective at getting smokers to quit, which would be better for their health and for reducing health care spending generally. According to the American Lung Association, while the surcharges may help offset the cost of smoking-related diseases, such punitive measures “have not been proven effective in encouraging smokers to quit or reducing tobacco use.”

Wellness programs that include smoking cessation may be a better alternative to punitive measures like tobacco surcharges.

For the complete article in USA Today, click here.

Over the next four years, 78% of employers anticipate making moderate to significant changes to their health plan design and vendor strategies. The goal of these changes is to keep cost increases at the current level, 4%, which was the smallest increase in 15 years (but still twice the Consumer Price Index).

These are the findings of the Willis Towers Watson 2016 Emerging Trends in Health Care Survey, which surveyed 467 large employers, collectively representing 12.1 million employees.

The survey also found that while new requirements under the Affordable Care Act have been a source of concern generally, 70% of employers said the recent two-year delay of the Cadillac tax has had a small or even negligible impact on their health care strategies for next year.

Some strategies employers are adopting to manage cost increases include adopting telemedicine, centers of excellence, high performance provider networks, onsite or near-site health centers, and technology to improve employee engagement.

To read more on plans employers have for managing health care costs, click here.

Sherri Bockhorst

For highlights of my perspectives in articles and other forums, see links 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 Joe Murad and John Barkett.

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

Horsing around with Dusty

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.

Sailing with son, George

 

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.

2015 is almost over, and it was another eventful year in health care. The most read blog posts on the OneExchange blog show the range of interests among readers of this blog.

Taken together, our series on Towers Watson exchange solutions leaders topped your list, with a post on the rise of account based health plans ranking a strong second. How employees are under-utilizing Employer Assistance Programs (EAPs) also landed near the top of the list.

A bit further down, the U.S. Supreme Court’s historic 6-3 decision in the case of King v. Burwell captured your attention. The decision reaffirmed allowing subsidies on both state and federal exchanges, ensuring that a key provision of the Affordable Care Act (ACA) — one that is largely responsible for the gains in insuring the uninsured — would remain in place. Director of Policy Affairs for Towers Watson’s Exchange Solutions, John Barkett, explained the case’s implications in our blog post on the topic.

You also were interested in public sector adoption of private retiree exchanges, as evidenced by the popularity of posts on the Ohio Public Employees Retirement System OPERS and Alameda County in California announcements that they were transitioning their retirees to OneExchange. Towers Watson’s acquisition of Acclaris, a provider of software-as-a-service (SaaS)-based technology and services for consumer-driven health plan and reimbursement accounts, also garnered interest as did the news that Towers Watson was a founding member of the Association of Web-Based Health Insurance Brokers (AWHIB), formed to advocate for policies that would enhance the efficiency of web-based brokers when they enroll people in public exchange insurance plans.

2016 will be another busy year for health care, especially as the U.S. elects a new president. Aside from this major event, next year’s hot topics remain to be seen.

Happy Holidays and Happy New Year!

Recent research from The Commonwealth Fund, a private foundation that aims to promote a high-performing health care system, explored how the ACA’s reforms of the individual health insurance market are working. Researchers compared the cost of subsidized plans offered on public exchanges with non-subsidized plans available off exchanges to determine the validity of early concerns that lower risk customers would prefer off-exchange plans. If that were to happen, the number of individuals needing government subsidies and subsidy amounts for plans on exchanges would increase — thwarting the ACA’s goal of offering good coverage at relatively low prices on public exchanges.

In fact, just the opposite has proven to be true. Richer plans that typically appeal to people with health problems make up a greater proportion of plans sold off exchanges than on them. According to the researchers, this means that the ACA’s provisions that discourage this type of risk segmentation are working.

Premium increases tell the story

To make this determination, researchers looked at 2015 premium increases, based on insurers’ federal filings for ACA-compliant plans both on and off exchanges. They found that the average premium for plans in the individual market increased $30 per person per month overall, with the average premium for plans purchased off exchanges ($34) higher than for on-exchange plans ($29). The reason for this premium increase differential has to do with the different preferences of purchasers, such as access to specific doctors or hospitals, which are met by plans bought directly from carriers compared with plans purchased on the public exchanges.

With the ACA, all plans are “guaranteed issue,” which means no one can be denied coverage because of preexisting conditions. This is great news for individuals who might have been denied coverage in the past due to an existing illness or chronic condition. However, the cost to the carriers of accepting everyone is higher.

On public exchanges, the higher cost is mitigated by restricting the doctors and other medical service providers that are considered “in-network,” a practice known as narrow networks. Off-exchange plans, which are offered directly by carriers, are not similarly constrained, giving purchasers access to a wider range of service providers — an appealing feature to people with existing health problems and established relationships with doctors and other providers.

The complete report is available from The Commonwealth Fund’s website.

One of the more controversial provisions of the Affordable Care Act (ACA), the excise tax on high-value health plans, goes into effect in 2018, and many employers are already making changes to the health plans they offer to avoid it. Among the changes are implementing narrow networks, transitioning to high-deductible health plans, and incentivizing participation in wellness programs that improve health and could reduce the incidence of chronic illness down the line.

With the open enrollment period for the 2016 plan year well underway, Sandy Ageloff, West Division leader of Towers Watson’s health and group benefits practice, underscored the importance of employers informing their employees of current and planned changes and what they mean.

In an article by Shelby Livingston of Business Insurance, Ageloff counseled employers to be sure that “employees are paying attention and understand the magnitude of change that might be happening in their employer’s benefit plan this year.”

To read the complete article in Business Insurance, click here.

Employers expect a 4.1% rate of increase in the cost of employer-sponsored health care benefits in 2015 – the lowest in 15 years but well above inflation — according to an annual survey by global professional services company Towers Watson (NASDAQ: TW) and the National Business Group on Health (NBGH), an association of large employers.

Nervertheless, the survey found that employers are more committed to providing some form of health care coverage to employees over the next 10 years than they have been in recent years. Employer confidence in offering health care coverage 10 years from now has nearly doubled to 44% today from 25% in 2014.

“Against the backdrop of sluggish economic growth and low inflation – which limits the degree to which companies can raise prices on goods and services – employers continue to aggressively manage their health benefit plans to rein in costs,” said Randall K. Abbott, a North American leader and senior strategist in Towers Watson’s Health and Group Benefits practice. “By and large, employers have done a good job managing costs in recent years. Despite this success, the ACA’s excise tax looms ahead in 2018, and 4 out of 5 employers now identify changes to health and pharmacy plan designs as their most important strategic priority.”

For more information about what additional actions employers are considering to manage costs, and additional survey findings, read the entire press release here.