 Agent and Consultant Briefing
April 2010 |
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 By: Cheryl DeMars
Laws are like sausages, it is better not to see them being made.
-Otto von Bismarck, Prussian/German statesman of the late 19th century
After a contentious and at times ugly process, federal health care reform is on its way to enactment after more than a year of intense debate. The Reconciliation Bill is expected to be signed into law today. The Alliance has been closely following this process, informing our members about the evolution of the reform plan and helping members communicate their thoughts to federal policymakers along the way.
The version of health care reform that recently passed the U.S. House includes ideas you have heard a lot about: a mandate for individuals to buy insurance and the creation of "exchanges" to deliver tax credits to lower income Americans and help them choose among insurance plans. The plan also includes a myriad of health insurance reforms aimed at making insurance more accessible to those without employer-sponsored health care, and system reforms intended to advance provider transparency and quality.
High-Impact Provisions for Employers
Specific to employers, the reconciliation bill:
- Requires employers with 51 or more employees to provide a certain level of health insurance to employees or face penalties.
- Employers that offer no insurance coverage must pay a penalty of $2,000 per full-time employee (excluding the first 30 employees) if even one of their employees accesses premium tax credits to buy health insurance through the exchange. Premium credits are available to individuals with incomes less than 400% of the federal poverty limit (in 2010, this is $43,320).
- Employers who offer coverage that is deemed unaffordable to at least some employees are also subject to a penalty. A plan is considered unaffordable if it pays less than 60% of likely medical expenses (actuarial value) or an employee's share of the premium exceeds 9.5% of his or her income. In these situations, the employer must pay an annual fee of $3,000 per worker who receives a premium credit, assessed monthly and capped at the amount described in the bullet above.
- Imposes a 40% excise tax on health benefits that exceed certain thresholds ($10,200 for singles and $27,500 for families with certain increases for higher cost workers) starting in 2018 and indexed at or near the general inflation rate thereafter. For more information about how the excise tax may affect our mutual clients, see our online excise tax calculator.
- Permits employers to discount up to 30% of the premium or cost sharing requirements for participation in a workplace wellness program. This may be increased to 50% at discretion of the U.S. Department of Health and Human Services.
- Imposes increased reporting and administrative requirements on employer plans.
Because the reform legislation affects nearly every facet of health care and health insurance delivery, there will undoubtedly be many questions for both The Alliance and for our member companies as it is implemented. Throughout this process, The Alliance is committed to helping members navigate any challenge. Together we will make this transition a new world for health benefits purchasing.
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| Primary Care Reduces Costs by a Third |
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Employees who have a relationship with a primary care physician cost about one-third less than employees who don't. That statement, which appeared in a now two-year old study, is one that would get most employers, who have tried everything from wellness and health promotion to value-based benefit design, thinking.
But Paul Grundy, Director of Healthcare, Technology and Strategic Initiatives for IBM Global Wellbeing Services and Health Benefits and Chairman of Patient-Centered Primary Care Collaborative, says thinking isn't enough, it's time for action.
"The opportunity to move the ball forward is very real and it is very now. You don't want your CEO asking you why you've never heard of the patient-centered medical home," Grundy says in What Is the Patient-Centered Medical Home?
What Is the Patient-Centered Medical Home? Although the name is complicated, the premise of the "medical home" is relatively simple. Basically, it ensures that each patient has an ongoing relationship with a primary care doctor. That doctor provides comprehensive care for the patient, from managing prevention efforts to coordinating the patient's care with other physicians so the patient receives the right care, not the most expensive.
Early reports show that it is making a difference:
- One system that incorporated the model saw a 20% reduction in hospital admissions.
- Another reduced asthma hospitalizations by 40% and asthma-related ER visits by 16%.
- A project focused on care for diabetic patients yielded a $500 per-patient annual savings.
Grundy will be discussing the concept at the next Alliance Learning Circle on April 7, and sharing how employers around the country are taking action now.
We'll also be featuring Larry Pheifer, of the Wisconsin Academy of Physicians, who will show how this may affect your health care costs and provide information about how this is being implemented in Wisconsin. Randall E. Gebhardt from Quantum Health will also present information about how Alliance employers with more than 200 employees across all plans can provide a "virtual" medical home to their employees today.
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| The Alliance Annual Seminar: Getting Serious about Health Strategy |
To be successful in today's competitive world-wide environment, organizations need healthy and high-performing people. But how do organizations accomplish that? They have been searching for that answer for more than 60 years.
Our annual seminar on May 4 will feature two speakers who will present a new answer to the question, transforming health strategy into an economic one:
- Dr. Dee Edington, University of Michigan, will present Health Management as a Serious Business and Economic Strategy. His presentation will focus on transforming the health strategy into an economic one using a population health management approach.
- Dr. Wendy Lynch, Health as Human Capital Foundation, will discuss how market economics explains why some organizations are so much more successful at promoting health and how it suggests new solutions.
Attendees will receive copies of both Dr. Edington's and Dr. Lynch's books. Immediately following their presentations, you'll have a chance to meet them both at a book signing and 20th anniversary celebration of The Alliance.
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| Flambeau Achieves Reduction in Health Care Costs with Consumer-Directed Health Plan |
Flambeau, Inc., a member of The Alliance since 2002, has seen a major, positive break from state and national medical trends for health benefit costs for its Wisconsin workforce from 2005 through 2008. They have achieved this by creating an easy to understand consumer-directed health plan. This new case study details Flambeau's experience. Read it today.
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| Watch for Your Health Care Benefits Survey |
Next week members will receive their Alliance Health Care Benefits survey. When they complete it by April 16th, they'll receive a $20 gift card. This survey is used to complete our annual SPD Analysis report and member participation helps us create the most valuable report.
Those who participate in the survey automatically receive a free copy of the final 2010 SPD Analysis report, which will summarize and compare plan design, plan options, and contribution levels across Alliance employers using the information obtained from members such as plan offerings, contributions, benefits, and health and wellness programs.
This report is a valuable resource to see how a plan matches up to other employers in The Alliance, to review trends and ideas for potential SPD changes over time, and to support employee communications about benefit plan decisions.
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| Resources for Employees to Improve Their Health and Wellness |
The Alliance Web site has a number of resources for employees that can positively impact their health:
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Patient Safety Toolkit: Here they'll learn how to avoid medical errors, understand a diagnosis, manage medications, prepare for medical visits, and talk to their doctor.
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How to Be a Better Health Care Consumer: These presentations teach individuals how to be a wise health care consumer. They'll not only learn that, but also more about the safety and quality of health care and how to maximize each health care visit.
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BabyLove: This service is designed to get pregnancy off on the right foot. It includes a health screening and a free copy of What to Expect When You're Expecting, What to Expect: The First Year or What to Expect: The Toddler Years.
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Diabetes Toolbox: If an individual has diabetes or knows someone who does, this provides tools to help them learn how to manage and live well with it.
In addition, they can also find a health care professional through our Find a Doctor function, learn more about quality and cost in QualityCounts™ and get assistance from our Customer Service Staff. This sheet includes complete details about what's available for individuals on our Web site. Members may also order copies of this piece. To do so, contact Tierney Jensen, 800.223.4139, x 6642.
Alliance staff is also available to present to employees on how to make better health care decisions and how to use the QualityCounts™ report. For information on our Better Health Care Consumer presentation, members should contact Jesse Oberloh. For QualityCounts, members should contact Bobbi Jones.
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| Alliance Staff Appointments and Accomplishments |
Alliance President and CEO Cheryl DeMars has been appointed to the Wisconsin Relay of Electronic Data (WIRED) for Health Board by Gov. Jim Doyle. The 15-member panel will develop plans for a statewide electronic health information exchange which will make it easier to transfer needed medical information from one hospital or clinic to another.
Carlene Boehmer, Alliance manager of claims and customer service, recently completed a TPA Request for Information project as part of her work with the National Business Coalition on Health's Direct Contracting Committee.
The workgroup conducted a thorough review of existing TPA Request for Proposals (RFPs) and Requests for Information (RFIs) and then developed a master list of questions including a rate sheet for NBCH's RFI.
The TPA RFI is available for Alliance members and partners through our membership in NBCH. You can download it here.
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| Support Wisconsin's Locally Owned Farms and Help Employees Eat Healthy |
Community supported agriculture (CSA) is an arrangement between local farms and households. Households pay a fee to the farm, which entitles them to a "share" of the farm's harvest. Each week, or sometimes every other week, the individual then picks up a box of fresh foods from the farm. Many farms also offer individuals a chance to visit the farm and work off a portion of their fee by picking or packing boxes.
CSA shares have caught on in the past few years, and are helpful to farms and to individuals who want access to fresh, healthy foods. The Madison Area CSA Coalition, which consists of 42 farms throughout Wisconsin, is eager to help employers provide their employees with more information about this unique arrangement.
Sharing information with employees about CSAs is a great first step to helping them eat healthier this summer and fall. Employers may also want to offer an incentive to their employees to participate in a CSA by offering to pay part of their CSA share. Even a small amount, such as $25, can help.
Many farms fill up early, so the time to promote CSAs is now. For more information and a list of farms, visit www.macsac.org and www.macsac.org/farmlist.html.
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| Free Wellness Resources from WELCOA |
| The Wellness Councils of America's (WELCOA) mission as a national not-for-profit is to advance the cause of workplace wellness. They offer a number of free reports on the subject of wellness for business and health professionals. You can access these free resources here.
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| Building Our Cooperative |
Please join us in welcoming the following new member to the cooperative:
Brooks Tractor will join The Alliance on April 1. Celebrating 65 years in business in 2010, Brooks Tractor provides tractors and other equipment for rent or ownership, and is focused on providing cost-effective equipment solutions and the best support to their customers. We welcome them to The Alliance.
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| Alliance Provider Update |
The Alliance encourages employers to distribute the monthly Provider Update listing to their employees.
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| QualityCounts™ for Employees |
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| News You Can Use |
The Alliance highlights health care and benefit management news for employers in News You Can Use with a link to take you to the original story or report.
Read about a recent study that found two common hospital-acquired infections, sepsis and pneumonia, killed 48,000 people and raised health costs by $8.1 billion in 2006 alone.
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| About the Agent and Consultant Briefing |
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Each month, The Alliance Agent and Consultant Briefing delivers the latest news to insurance agents and consultants about Alliance services, programs and events as well as information on health benefit trends, issues and ideas of interest to our mutual clients.
Reader comments, suggestions and topics are always welcome.
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