Health Affairs: Engaging Health Care Consumers: The Lowe’s Experience

Worth reading and NBCH's recent study with Benz Communications is noted...

A recent post for the Health Affairs blog by Bob Ihrie, senior vice president of compensation and benefits for Lowe's, and Dr. Alan Spiro, chief medical officer for Accolade, outlined Lowe's evolution to better engage employees through its population health and benefits program.

Time will tell, but it appears that employers are not giving up on providing health insurance to their employees — even with the availability of health care exchanges. That’s at least what the results of a new study sponsored by the National Business Coalition on Health (NBCH) suggest.

Brian Klepper, CEO of the NBCH, speculated in his recent Health Affairs Blog post: “…there is an alternative view of what is possible in health care, and that self-funding and a willingness to continue trying to control the health care value monster remains alive and vibrant.”

As self-funded employers strive for a value-based health care marketplace, they’re looking at ways to drive value at an individual level — through strategies to engage employees as better consumers and managers of their own health care.

Over the last couple of decades, Lowe’s has been on a journey to encourage its employees to become engaged health care consumers. What Lowe’s experience teaches us is that health care systems are complex, and individuals value guidance from a trusted source, particularly when faced with difficult or challenging decisions...

OPM Confirms Blue Cross Blue Shield Will Offer Multi-State Plans

The Office of Personnel Management (OPM) has released details about the multi-state plans that will be offered on the exchanges of 30 states and the District of Columbia. The Blue Cross Blue Shield Association, a non-profit confederation of regional Blues plans, signed a contract this month with OPM to offer the plans, which are supposed to expand to all 50 states in the next four years under the health care law. Blue Cross already operate plans in all 50 states.

The plans were meant to drive competition on the exchanges, but many experts have been skeptical that they will be much more than a rebranded clone of plans already offered in the same markets. The reason is that it’s difficult for insurers to build provider networks and market themselves in areas where they aren’t already offering coverage.

Alissa Fox, vice president of policy at BCBSA, said that 2014 will be a “phase-in year” for multi-state plans, but that already they “are offering a wider range of networks” than other plans on the exchanges. In a fact sheet posted today, OPM said that multi-state plans are increasing consumer options. Without those plans, consumers would have access to just one type of plan in Alaska, New Hampshire, and West Virginia.

Small Businesses Unaware of Exchange Notification Requirements

Bloomberg Businessweek reports that, though the deadline is less than a month away, many small businesses don’t know they have to notify employees about the health insurance exchanges in their states. Small business owners are either unaware of the requirement, or are under the misconception that it doesn’t apply to them because they’re too small to be governed by the health care reform law’s mandate. But the notification requirement applies to any business regulated under the Fair Labor Standards Act, which covers all companies with at least one employee and $500,000 in annual revenue. Penalties for businesses that don’t comply could reach $100 per worker per day.  The notifications must be supplied by October 1, 2013.

HHS Awards $67 Million in Exchange Navigator Grants

Health and Human Services (HHS) Secretary Kathleen Sebelius has announced $67 million in grant awards to 105 Navigator grant applicants in federally-facilitated and state partnership exchanges. These Navigator grantees and their staff will serve as an in-person resource for individuals who want additional assistance in shopping for and enrolling in plans in the exchanges beginning this fall. The $67 million was more than the originally estimated $50 million, and comes entirely out of the ACA-created Prevention and Public Health Fund.

Navigators will be trained to provide unbiased information in a culturally competent manner to consumers about health insurance, the new exchanges, qualified health plans, and public programs including Medicaid and the Children’s Health Insurance Program. The Navigator funding opportunity announcement was open to eligible private and public groups and people who are self-employed who met certain standards to promote effectiveness, diversity, and program integrity.

Navigators will be required to adhere to strict security and privacy standards – including how to safeguard a consumer’s personal information. They will be required to complete 20-30 hours of training to be certified, will take additional training throughout the year, and will renew their certification yearly.

Study: Consumers Don't Understand the Health Insurance They Have Now

A new study by George Loewenstein, to be published in the September issue of the Journal of Health Economics shows that those who currently have health insurance, including employer-sponsored plans, have a poor understanding of their coverage. Loewenstein and a team of researchers commissioned two surveys of covered Americans and found that only 14% could explain all four key health insurance concepts: deductible, copay, coinsurance, and out-of-pocket maximum. Only 11%, given all the necessary information, could calculate the cost of a four-day hospital stay to within $1,000. 

The findings articulate the conundrum employers face when offering health insurance to their employees: consumers do not understand traditional plans and would better understand a simplified plan, but a simplified plan would not have strong appeal to consumers, or cause them to change their health care choices. This is especially critical information for employers as they start to devise a communications strategy around their current health insurance offerings as they relate to exchanges and tax credits that may be available; employers should be looking to their coalitions for help on developing employee communications strategies.

Many State-Run Health Insurance Exchanges Set to Exceed Requirements for Plan Choice, Quality Reporting

Consumers and small businesses in states that have opted to run their own health insurance exchanges will likely have a greater ability to make informed choices regarding their coverage as well as more information about plan quality than what current federal regulations require, a new Commonwealth Fund report finds. The report, by researchers from Georgetown University's Health Policy Institute, examines the key design decisions made by the 17 states that, along with the District of Columbia, chose to establish their own exchanges. Use the Commonwealth Fund's interactive map to explore how health insurance exchanges are shaping up across the U.S., or read a Health Affairs primer on the exchanges and what lies ahead.

HHS OIG Report on Co-Op Program

The HHS Office of Inspector General (OIG) recently conducted a study of the Consumer-Oriented and Operated Plan Loan Program, commonly referred to as the CO-OP program. Authorized by the ACA, the CO-OP program foster the creation of nonprofit, consumer-governed health insurance issuers called CO-OPs that will offer qualified health plans in the individual and small group markets.

Goals of the CO-OP program include promoting integrated care, quality, and efficiency. As of January 2, 2013, the Centers for Medicare & Medicaid Services (CMS) had awarded loans totaling $1.98 billion to 24 CO-OPs. The applicants that receive this funding are new entities that may face financial and operational challenges in a competitive insurance market. CMS manages the CO-OP program and must implement it in a short time so that CO-OPs will be ready to enter the exchanges.

The OIG report found that despite challenges, CO-OPs have made progress toward achieving licensure and met 90 percent of their milestones during the period of review from February through September 2012. CMS's oversight strategy includes frequent monitoring and early intervention to ensure that CO-OPs adhere to program requirements and goals. Although CO-OPs appear to be making progress, they are still hiring staff, obtaining licensure, and building necessary infrastructure. In addition, the extent to which any particular CO-OP can achieve program goals depends on a number of unpredictable factors, such as each Exchange's operations, market competition, and enrollment.

HHS Finalizes Exchange Rule

HHS has published the final rule explaining who is exempt from the individual mandate penalty. Would-be Medicaid beneficiaries who lose out on coverage because their states choose not to expand the insurance program for the poor will not have to pay the individual mandate penalty. The rule also says those who go without insurance for three months or less won’t be on the hook, and it spells out alternative types of insurance — self-funded student plans, for instance — that will qualify as meeting the standards for minimum coverage.

The rule also includes an exemption for those caught up in the so-called family glitch involving how the government will gauge whether coverage is affordable and who gets subsidies.The glitch stems from an IRS rule that outlines which employees will be eligible for tax credits. If the cost of individual coverage — but not family coverage, which is far more costly — exceeds 9.5 percent of the worker’s household income, the worker would be eligible for a credit. The administration chose not to base eligibility on family coverage because it would have been too expensive for the government. The new rule would cut those subject to the family glitch a break by exempting family members from the mandate penalty if the cost of covering the whole family is deemed unaffordable.

Employers will not be subject to a shared responsibility payment for employees who do not buy insurance because they claim financial hardship exemptions, or religious belief exemptions.

Brookings Institution Health Insurance Exchanges Implementation Webinar

The Brookings Institution is hosting a webinar on Tuesday, June 25 featuring a panel presentation on the status of implementation of the new health insurance exchanges.

Hosted by the Engelberg Center for Health Care Reform at Brookings, the panel presentation will run from 9:00 a.m. to 11:30 a.m. EDT and will be co-moderated by Dr. Mark McClellan, Director of the Engelberg Center for Health Care Reform and the Leonard D. Schaeffer Chair in Health Policy Studies at the Brookings Institution and Governor Michael Leavitt, Founder and Chairman of Leavitt Partners. Additionally, the event will feature senior officials from the Centers of Medicare and Medicaid (CMS)—Gary Cohen, Deputy Administrator and Director of the Center for Consumer Information and Insurance Oversight and Mandy Cohen, Senior Technical Advisor—who will provide an overview and update on the health insurance marketplace implementation including outreach, education, and system requirements for coordinating data flows, as CMS works to advance the diverse processes for successful implementation.

You can register for the webinar here.

Will Consumers Sign On For Health Law’s Co-Ops?

Kaiser Health News and the Washington Post examine the likelihood of consumers choosing Co-Ops (Consumer Owned and Operated Plans) when they go onto the health insurance exchanges this fall. This fall is the moment of truth for 24 Co-Op plans created by the Affordable Care Act to increase competition and give consumers a greater say in their coverage. Funded by $1.9 billion in low-interest federal loans, the co-ops were tucked into the law as a compromise with those who had unsuccessfully sought a so-called “public option,” or government-run insurance plan.

But will customers buy insurance from upstart non-profits? And will the co-op plans be competitive with those offered by industry giants like UnitedHealthcare and Aetna which have the clout to exact big discounts from hospitals and doctor groups?

Four months before the opening of new online health insurance exchanges where the plans will be sold, there are some positive early signs: Proposed premiums in Oregon – one of a number of states to publish preliminary figures – compare favorably to what commercial plans are charging. A single nonsmoking 40-year-old will be able to choose a basic policy for $234 a month from Oregon’s Health CO-OP, or $251 a month from Freelancers CO-OP, which will also operate in the state. Comparable plans from other companies will cost from $169 to $422 a month, state data show. Still, there is skepticism in some quarters, especially from commercial insurers who say Co-Ops have an unfair advantage with their low-interest loans from the feds.

Several NBCH member coalitions are working on Co-Ops in their states.

Aetna, UnitedHealthcare join Maryland’s health exchange

Residents of Maryland know more this morning about their insurance options on the state’s health insurance exchange. Aetna and UnitedHealthcare are among the 13 insurers who will provide medical benefits for those 730,000 uninsured in the state who choose to gain coverage through the exchange.

California residents who choose to buy health insurance through the state exchange also found out the insurers offering coverage on the marketplace. Californians on the exchange may also end up paying higher premiums.

WellPoint Inc., Molina Healthcare Inc. and Health Net Inc. are among 13 insurers selected to participate in the most-populous U.S. state’s health exchange, which begins enrollment Oct. 1. While the rates the companies will charge vary widely depending on a person’s circumstance, the director of the exchange says that premium increases will be less than the 30% jump projected by consulting company Milliman Inc.

Read the full article here.

Oregon Insurers Rethink 2014 Exchange Premiums as State Posts First-Ever Rate Comparison

The new health insurance marketplace envisioned by federal health reforms doesn't formally kick in until fall. But it already is taking shape – and consumers for the first time can compare, premium by premium, identical plans by different insurers. According to The Oregonian, a comparison of proposed 2014 health premiums became public online this week, causing two insurers to request do-overs to lower their rates even before the state determines whether they're justified. The unusual development was sparked by a comparison that used to be impossible because plan benefits varied so widely. But under the federal reforms in the Affordable Care Act that take effect Jan. 1, health insurance is mandated and every insurer must offer certain standard plans, known as Essential Health Benefits. Oregon's state-based health insurance exchange - Cover Oregon - allows for much easier apples-to-apples comparisons among health insurance plans than exists currently in the individual insurance market.

CMS Releases Guidance on Role of Brokers and Agents in Exchanges

The Center for Consumer Information and Insurance Oversight (CCIIO) within CMS has released a new guidance document describing the roles agents and brokers can play in the new ACA-created health insurance exchanges. The guidance acknowledges that agents and brokers have an important role to play in helping consumers - both individuals and small businesses - understand the new exchanges.

Section I of this document provides a high-level overview of the role of agents and brokers, including web-brokers, in federally-facilitated exchanges and state partnership model exchanges. In section II, CMS addresses common questions raised by states and other stakeholders on the role of agents and brokers in all exchanges, including state-based exchanges. In section III, CMS addresses questions specific to web-brokers. The guidance document also contains a process flowchart to illustrate how agents and brokers will assist consumers through both the issuer-based and exchange pathways.

Agents and brokers intending to work with consumers in federally-facilitated and state partnership exchanges will be able to assist consumers in two ways: (a) an issuer-based pathway, through which an agent or broker uses an issuer’s website to assist the consumer; or (b) an exchange pathway, through which an agent or broker assists the consumer using the exchange website. In states where a federally-facilitated or partnership is operating, all agents and brokers must register with CMS and complete a training course. This online registration process administered by CMS will begin in the summer of 2013, prior to open enrollment. Agents and brokers working in states with state-based exchanges will still need to register with the state exchange and follow any processes and requirements of that state exchange.

HHS Publishes Exchange Enrollment Applications

The Department of Health and Human Services has published the final enrollment forms that individuals and families will use when applying for coverage through the ACA health insurance exchanges.  Both applications are considerably shorter than the proposed versions.  The individual application is now only three pages long, and the family application is now seven pages long.  The applications are based on a "no wrong door" approach to enrollment, meaning that an applicant fills out one form, and the exchange assists that applicant in enrolling in the coverage most appropriate for his or her situation, including government programs such as Medicaid, CHIP, or veterans' and military benefits.

An appendix to the family application includes an Employer Coverage Tool, which is a one-page form that employees can take to their employers, and request that the employer fill out information regarding the coverage offered to employees.  Employers have assumed that they would need to interact with exchanges in some fashion, and the form confirms that employees themselves will be the link between employers and the exchanges in making eligibility determinations.  The Employer Coverage Tool also asks whether the employer plans to make any changes to its health insurance benefit offerings within the next year.

CMS releases final rule on ACA

CMS has released the long awaited final rule on the ACA’s essential benefits, actuarial value and accreditation requirements which provides importance guidance to states and health plans for the implementation of public insurance exchanges starting in 2014.

NBCH staff will be reviewing the final regulations and will be reporting to its members on any surprises in the final rule and any important implications for the employer community.

ACA HIX deadline for employers pushed back

According to Politico, the administration is pushing back an ACA deadline for employers to inform workers about health insurance exchanges. Additional details are available in this FAQ released today.

The ACA originally called for employers to provide employees with a written notice no later than March 1, but the Department of Labor (DOL) has pushed the date back to late summer or fall — around the time of open enrollment for exchanges. The DOL determined the employer notice should be timed with HHS outreach efforts and IRS guidance on minimum value, and the administration said the extra time would help employers.