Employee Benefits and the New Health Care Landscape

Introduction&nbsp;&nbsp;&nbsp;&nbsp; 1 <br>Attracting and Retaining Employees&nbsp;&nbsp;&nbsp;&nbsp; 3 <br>A New Paradigm Shift for Benefits&nbsp;&nbsp;&nbsp;&nbsp; 5 <br>The Exchange Evolution&nbsp;&nbsp;&nbsp;&nbsp; 8 <br>“Try It, You’ll Like It”&nbsp;&nbsp;&nbsp;&nbsp; 9 <br>Overcoming the “Wait and See” Mindset&nbsp;&nbsp;&nbsp;&nbsp; 11 <br> <br> PART I:&nbsp; THE CHANGING BENEFITS LANDSCAPE&nbsp;&nbsp;&nbsp;&nbsp; 13<br>Chapter 1&nbsp; Building a Better Benefits System&nbsp;&nbsp;&nbsp;&nbsp; 15 <br>Principle #1: Give Them Money and Let Them Shop&nbsp;&nbsp;&nbsp;&nbsp; 19 <br>Principle #2: Provide True Price Transparency&nbsp;&nbsp;&nbsp;&nbsp; 23 <br>Principle #3: Provide Meaningful Choice&nbsp;&nbsp;&nbsp;&nbsp; 24 <br>Principle #4: Offer Guidance in the Form of Decision Support&nbsp;&nbsp;&nbsp;&nbsp; 27 <br>Principle #5: Optimize the Shopping Experience&nbsp;&nbsp;&nbsp;&nbsp; 29 <br>Principle #6: Ensure a Cultural Fit Within the Organization&nbsp;&nbsp;&nbsp;&nbsp; 33 <br>Principle #7: Refine, Iterate, and Improve&nbsp;&nbsp;&nbsp;&nbsp; 33 <br> Chapter 2&nbsp; Benefits: The Accidental Entitlement&nbsp;&nbsp;&nbsp;&nbsp; 35 <br>Not Really an “Exchange”&nbsp;&nbsp;&nbsp;&nbsp; 38 <br>“Modern-Day” Insurance&nbsp;&nbsp;&nbsp;&nbsp; 40 <br>Benefits as Compensation&nbsp;&nbsp;&nbsp;&nbsp; 41 <br>So Where Does This Leave Us?&nbsp;&nbsp;&nbsp;&nbsp; 46 <br>Brokers Join the Bandwagon&nbsp;&nbsp;&nbsp;&nbsp; 49 <br> Chapter 3&nbsp; They Don’t Know What They’re Missing: Flipping the Status Quo on Its Head&nbsp;&nbsp;&nbsp;&nbsp; 51 <br>The Problem with the Status Quo&nbsp;&nbsp;&nbsp;&nbsp; 53 <br>Disrupting the Status Quo&nbsp;&nbsp;&nbsp;&nbsp; 56 <br>&nbsp;&nbsp;&nbsp; Meaningful Choice&nbsp;&nbsp;&nbsp;&nbsp; 57 <br>&nbsp;&nbsp;&nbsp; Price Transparency and Defined Contribution&nbsp;&nbsp;&nbsp;&nbsp; 59 <br>&nbsp;&nbsp;&nbsp; Personalization&nbsp;&nbsp;&nbsp;&nbsp; 67 <br>&nbsp;&nbsp;&nbsp; Consumerism&nbsp;&nbsp;&nbsp;&nbsp; 70 <br> Chapter 4&nbsp; Making Sense of Benefits Solutions: Public Exchanges and Private Exchanges&nbsp;&nbsp;&nbsp;&nbsp; 75 <br>The View from the Top: Public Versus Private Exchanges&nbsp;&nbsp;&nbsp;&nbsp; 75 <br>Who Runs These Things Anyway? Types of Private Exchange Operators&nbsp;&nbsp;&nbsp;&nbsp; 79 <br>&nbsp;&nbsp;&nbsp; Pure-Play Providers&nbsp;&nbsp;&nbsp;&nbsp; 79 <br>&nbsp;&nbsp;&nbsp; Benefits Providers&nbsp;&nbsp;&nbsp;&nbsp; 80 <br>&nbsp;&nbsp;&nbsp; Benefits Advisors&nbsp;&nbsp;&nbsp;&nbsp; 80 <br>&nbsp;&nbsp;&nbsp; Traditional Benefits Administration Companies&nbsp;&nbsp;&nbsp;&nbsp; 81 <br>What Should You Consider When Moving to a Private Exchange?&nbsp;&nbsp;&nbsp;&nbsp; 83 <br>&nbsp;&nbsp;&nbsp; Single- Versus Multi-Carrier Exchanges&nbsp;&nbsp;&nbsp;&nbsp; 83 <br>&nbsp;&nbsp;&nbsp; Self- Versus Fully-Insured Models&nbsp;&nbsp;&nbsp;&nbsp; 84 <br>&nbsp;&nbsp;&nbsp; Funding Strategies&nbsp;&nbsp;&nbsp;&nbsp; 86 <br>Who Can Benefit from Private Exchanges? Markets Served&nbsp;&nbsp;&nbsp;&nbsp; 86 <br>A Look at Products in Private Exchanges&nbsp;&nbsp;&nbsp;&nbsp; 89 <br>What Else Can Private Exchanges Offer?&nbsp;&nbsp;&nbsp;&nbsp; 95 <br> <br> PART II:&nbsp; STAKEHOLDERS: MAKING THE MOVE FROM “ONE SIZE FITS ALL”&nbsp;&nbsp;&nbsp;&nbsp; 97<br>Chapter 5&nbsp; Employers Find Skin in the Game&nbsp;&nbsp;&nbsp;&nbsp; 99 <br>A Big Bet Pays Off: TitleMax, Part of the TMX Finance Family of Companies&nbsp;&nbsp;&nbsp;&nbsp; 100 <br>Customer-Focused Luxury Resort Gives Back to Its Employees: Sandestin&nbsp;&nbsp;&nbsp;&nbsp; 104 <br> Chapter 6&nbsp; Six Questions to Ask Before You Choose a Private Exchange&nbsp;&nbsp;&nbsp;&nbsp; 109 <br>What Makes for a True Private Exchange?&nbsp;&nbsp;&nbsp;&nbsp; 111 <br>&nbsp;&nbsp;&nbsp; 1 Is Elasticity Built into Its Foundation?&nbsp;&nbsp;&nbsp;&nbsp; 113 <br>&nbsp;&nbsp;&nbsp; 2 Does It Include Decision Support and Educational Tools?&nbsp;&nbsp;&nbsp;&nbsp; 114 <br>&nbsp;&nbsp;&nbsp; 3 Are Prices Transparent?&nbsp;&nbsp;&nbsp;&nbsp; 116 <br>&nbsp;&nbsp;&nbsp; 4 Does It Integrate with Value-Added Services?&nbsp;&nbsp;&nbsp;&nbsp; 118 <br>&nbsp;&nbsp;&nbsp; 5 Does It Provide Year-Round Support?&nbsp;&nbsp;&nbsp;&nbsp; 119 <br>&nbsp;&nbsp;&nbsp; 6 To What Extent Does It Handle Benefits Administration?&nbsp;&nbsp;&nbsp;&nbsp; 120 <br> Chapter 7&nbsp; Brokers and Exchanges: Better Together&nbsp;&nbsp;&nbsp;&nbsp; 123 <br>Rick Strater, Arthur J Gallagher &amp; Co&nbsp;&nbsp;&nbsp;&nbsp; 127 <br>&nbsp;&nbsp;&nbsp; The Role of the Broker&nbsp;&nbsp;&nbsp;&nbsp; 128 <br>&nbsp;&nbsp;&nbsp; Overcoming Misconceptions&nbsp;&nbsp;&nbsp;&nbsp; 128 <br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Employees Don’t Care About Choice&nbsp;&nbsp;&nbsp;&nbsp; 128 <br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Cost Is All That Matters&nbsp;&nbsp;&nbsp;&nbsp; 129 <br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Defined Contribution Is “Cost Shifting”&nbsp;&nbsp;&nbsp;&nbsp; 129 <br>Rob Harkins, Willis Towers Watson&nbsp;&nbsp;&nbsp;&nbsp; 130 <br>&nbsp;&nbsp;&nbsp; The Changing Role of Brokers&nbsp;&nbsp;&nbsp;&nbsp; 131 <br>&nbsp;&nbsp;&nbsp; How Can Brokers Win?&nbsp;&nbsp;&nbsp;&nbsp; 131 <br>&nbsp;&nbsp;&nbsp; The Role of HR&nbsp;&nbsp;&nbsp;&nbsp; 133 <br>&nbsp;&nbsp;&nbsp; Technology Is the Future of Benefits&nbsp;&nbsp;&nbsp;&nbsp; 133 <br> Chapter 8&nbsp; Insurers Find a New Way to Move Product&nbsp;&nbsp;&nbsp;&nbsp; 137 <br>The Private Exchange: A Bridge to the Future?&nbsp;&nbsp;&nbsp;&nbsp; 139 <br>What Insurers Can Gain from Private Exchanges&nbsp;&nbsp;&nbsp;&nbsp; 143 <br>Innovators Embrace Private Exchanges Early On&nbsp;&nbsp;&nbsp;&nbsp; 148 <br>&nbsp;&nbsp;&nbsp; Jessica Moser, MetLife&nbsp;&nbsp;&nbsp;&nbsp; 148 <br>&nbsp;&nbsp;&nbsp; Kevin Hill, Oxford Health Plans/UnitedHealthcare&nbsp;&nbsp;&nbsp;&nbsp; 150 <br>Insurers Aren’t the Only Ones Innovating&nbsp;&nbsp;&nbsp;&nbsp; 152 <br> <br> PART III:&nbsp; FUTURE VISION&nbsp;&nbsp;&nbsp;&nbsp; 155<br>Chapter 9&nbsp; Innovation in Benefits (Yes, Benefits)&nbsp;&nbsp;&nbsp;&nbsp; 157 <br>Expanding the Aisles in the Benefits Store&nbsp;&nbsp;&nbsp;&nbsp; 163 <br>Letting Individuals Create Their Own Preferred Networks&nbsp;&nbsp;&nbsp;&nbsp; 165 <br>Creating a National Individual Insurance Market&nbsp;&nbsp;&nbsp;&nbsp; 169 <br> Chapter 10&nbsp; The “Law of the Land,” Insurance Tax Reform, and the November Surprise&nbsp;&nbsp;&nbsp;&nbsp; 175 <br>“The Law of the Land…for the Foreseeable Future”&nbsp;&nbsp;&nbsp;&nbsp; 178 <br>The Viability of the Individual Market&nbsp;&nbsp;&nbsp;&nbsp; 183 <br>What Else to Note on the Legislative Front&nbsp;&nbsp;&nbsp;&nbsp; 185 <br>&nbsp;&nbsp;&nbsp; The “Cadillac” of Taxes—And Other Pending Legislation&nbsp;&nbsp;&nbsp;&nbsp; 186 <br>&nbsp;&nbsp;&nbsp; The Medicare Marketplace as a Model&nbsp;&nbsp;&nbsp;&nbsp; 187 <br>&nbsp;&nbsp;&nbsp; Small Businesses and Individual Benefits Marketplaces&nbsp;&nbsp;&nbsp;&nbsp; 188 <br>&nbsp;&nbsp;&nbsp; Tweaking the Tax Code&nbsp;&nbsp;&nbsp;&nbsp; 190 <br> Chapter 11&nbsp; Who’s Afraid of the American Consumer?&nbsp;&nbsp;&nbsp;&nbsp; 193 <br>Some Potential Ways Forward&nbsp;&nbsp;&nbsp;&nbsp; 196 <br>&nbsp;&nbsp;&nbsp; Tax-Protected Savings Accounts&nbsp;&nbsp;&nbsp;&nbsp; 197 <br>&nbsp;&nbsp;&nbsp; Employer Funding for Individual Insurance&nbsp;&nbsp;&nbsp;&nbsp; 198 <br>&nbsp;&nbsp;&nbsp; Consumer-Centric Provider Networks&nbsp;&nbsp;&nbsp;&nbsp; 200 <br>&nbsp;&nbsp;&nbsp; Data and Digital Tools for Patients and Consumers&nbsp;&nbsp;&nbsp;&nbsp; 201 <br>&nbsp;&nbsp;&nbsp; Patient-Empowered Healing&nbsp;&nbsp;&nbsp;&nbsp; 204 <br>The Utopian Vision&nbsp;&nbsp;&nbsp;&nbsp; 206 <br>&nbsp;&nbsp;&nbsp; Shopping for Care&nbsp;&nbsp;&nbsp;&nbsp; 208 <br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Using a Marketplace to Purchase Non-Emergent Health Care on an As-Needed Basis&nbsp;&nbsp;&nbsp;&nbsp; 209 <br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; An “In-Network” Conundrum?&nbsp;&nbsp;&nbsp;&nbsp; 212 <br>Final Thoughts&nbsp;&nbsp;&nbsp;&nbsp; 213 <br> <br> PART IV:&nbsp; APPENDIXES: A PRACTICAL GUIDE TO PRIVATE EXCHANGES&nbsp;&nbsp;&nbsp;&nbsp; 215<br>Appendix A&nbsp; Private Exchanges 101&nbsp;&nbsp;&nbsp;&nbsp; 217<br>Appendix B&nbsp; Making Sense of Benefits Terms&nbsp;&nbsp;&nbsp;&nbsp; 223 <br>Terms Related to Benefits&nbsp;&nbsp;&nbsp;&nbsp; 223 <br>Terms Related to Health Care Consumerism&nbsp;&nbsp;&nbsp;&nbsp; 226 <br>Terms Related to Private Exchanges&nbsp;&nbsp;&nbsp;&nbsp; 227 <br>Guide to Common Benefits Products on a Private Exchange&nbsp;&nbsp;&nbsp;&nbsp; 230 <br> Appendix C&nbsp; Real-World Data and Applications&nbsp;&nbsp;&nbsp;&nbsp; 233 <br>What Really Happens on Private Exchanges?&nbsp;&nbsp;&nbsp;&nbsp; 233 <br>&nbsp;&nbsp;&nbsp; Data from the 2017 Private Exchange Research Council (PERC) Analysis&nbsp;&nbsp;&nbsp;&nbsp; 233 <br>What Do Employers and Employees Really Think About Liazon Exchanges?&nbsp;&nbsp;&nbsp;&nbsp; 237 <br>&nbsp;&nbsp;&nbsp; Data from the Liazon 2017 Employer and Employee Surveys&nbsp;&nbsp;&nbsp;&nbsp; 237 <br>&nbsp;&nbsp;&nbsp; The Exchange Experience: A Look at How Benefits Are Selected on Liazon Exchanges&nbsp;&nbsp;&nbsp;&nbsp; 240 <br>&nbsp;&nbsp;&nbsp; For the Benefits Geeks: A Health Care Timeline&nbsp;&nbsp;&nbsp;&nbsp; 246 <br> Index&nbsp;&nbsp;&nbsp;&nbsp; 251 <br> <br> <br>