Making the Most Out of Open Enrollment

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Nearly half of employees are stressed by the open enrollment process and only half are confident about the benefit decisions they made last year, according to a study by MetLife. Millennials are the most stressed and confused. When asked about the most effective benefit resources, respondents ranked one-on-consultations well above other resources. In fact, Millennials led their generational counterparts in valuing one-on-one consultations. However, only half of employers offer one-on-one consultations. Sixty percent of Millenials consult with their families and friends on benefits. MetLife says that employers need to help their employees connect the value of non-medical benefits to their day-to-day lives. Employers should also do the following:

  • Make sure that employees fully understand key terms such as “deductible,” “premium,” “PPO,” and “HMO.”
  • Have employees ask themselves, “Do I have a big life event coming up, such as marriage or retirement?” It’s critical to choose benefits based on present and future needs.
  • Make sure that employees review their benefits and fully understand them. Only half of employees said they thoroughly reviewed their benefits choices last year.

The survey also reveals how employees feel about their benefits:

  • Financial uncertainty: In contrast to decreasing unemployment numbers, American workers remain pessimistic about their financial future. Less than half feel in control of their finances. Even fewer expect their situations to improve in the next year (46% in 2015, compared to 52% in 2014). More than half are concerned about having enough money to cover out-of-pocket medical costs as well as meeting monthly living expenses and financial obligations. These worries that have increased every year since 2012.
  • Job Satisfaction: More than half of employees are satisfied with their jobs and are committed to the organizations’ goals. An increasing number plan to be with their companies a year from now.
  • Financial Benefits: 71% of employees consider work to be the foundation of their financial safety net. Sixty-two percent of employees want more financial security benefits. Millennials are more financially vulnerable compared to their counterparts. Gen Xrs say they are less secure than other generations.
  • Appreciation of benefits: Half of employees agree strongly that their benefits help them worry less about unexpected health and financial issues. Seventy percent of employees say that having customizable benefits would increase their loyalty to their employer.
  • Supplemental benefits: Employees continue to ask for a range of solutions, especially for more common benefits, such as medical, prescription, 401(k), dental, life, and vision care. Employers are keeping pace with many of their employees’ top benefit requests. However, there are large gaps in accident insurance, critical illness, and hospital indemnity. Most employers understand how non-medical benefits can provide financial protection, such as offsetting out-of-pocket medical expenses. Yet, only 47% of employees believe that supplemental health benefits can help close these gaps.
  • A streamlined plan design: Plan design, claims management, and implementation rank highly as advantages of streamlining the number of carriers that employers use.
  • Use of enrollment firms: Three-quarters of employers have positive attitudes towards enrollment firms. Seventy-one percent of employers say that working with an enrollment firm helped them improve benefit communications.
  • Wellness plans: More than two thirds of employees are interested in physical well-being programs that reward healthy behavior. This is especially true among Millennials (75%) and female employees (72%).
  • Retirement Benefits: Forty percent of employees say that having retiree benefits is a key reason to stay with their employer. Millennials feel the most strongly about this, probably due to their lack of financial confidence. About a third of employees plan to postpone retirement, an increase of 5% over 2015. Almost 6 in 10 employees plan to work or consult once retired. Of this 60%, 44% plan to work part-time.
  • Older workers: With today’s workers redefining what it means to be a retiree, employers must also redefine what retiree benefits look like in order to appeal to this rich reservoir of talent. For example, 63% of employees say that dental is a must-have retiree benefit while only 42% of employers offer it. Similar gaps can be found across other critical non-medical benefits, such as vision and life insurance. More than half of employees say that their employer does not offer any employer-paid non-medical benefits. With retiree benefits being such an important loyalty factor for many employees, employers have an opportunity to keep pace in 2016 and beyond.

HMOs Beat PPOs on Cost and Quality

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California’s commercial HMOs outperform commercial PPOs on most clinical quality measures. They also consistently provide less costly care. The average yearly cost is $4,245 per HMO enrollee versus $4,455 per PPO enrollee, according to the California Regional Health Care Cost & Quality Atlas. The report comes from the Integrated Healthcare Assn., the California Health Care Foundation, and the California Health and Human Services Agency. Differences in benefit designs don’t explain the cost variation since the total cost of care includes enrollee cost-sharing (deductibles and coinsurance) as well as insurance payments to providers.

HMOs may be performing better because they rely on integrated care networks, which generally accept capitation (fixed per-member, per-month payments). So they are accountable for the patients’ health and are generally rewarded for it, according to the report. So why is HMO enrollment declining? PPOs are often less costly for employers since they reduce premiums with higher enrollee cost-sharing, such as deductibles and coinsurance. But employers should look at the whole picture since HMOs produce superior results when you consider quality and the total cost of care, according to the report.

Quality of Care
California’s commercial HMOs perform better than their national counterparts on every clinical quality measure except asthma medication management. At the same time, California’s commercial PPOs perform worse than the national average on five of the six measures.

When Kaiser Permanente is removed from the analysis, the difference in clinical quality between HMOs and PPOs is cut by about half. Also, the performance difference on risk-adjusted total cost of care narrows substantially, but HMOs still outperform PPOs.

Quality is highest in Northern California, solid in Southern California, and weakest in Central California. The study reveals these regional differences is quality:

  • Northern California outperforms Central and Southern California on clinical quality.
  • Central California falls below the statewide average on key clinical measures for cancer, diabetes, and asthma.
  • The lowest performing region is the Eastern region 13, which includes Central California counties Mono, Inyo, and Imperial.
  • The highest performing region is Contra Costa County region in Northern California.
  • Clinical quality scores vary significantly on some measures. For example, 33% of commercial enrollees with diabetes in Alameda County region six have poorly controlled blood sugar, compared to 75% in the Eastern region 13.
  • In Southern California, San Diego County region 19 is the highest performing region, outperforming Northern California regions: San Mateo County region eight and San Francisco County region four.

If all commercially insured Californians got the same quality of care as top-performing regions, nearly 200,000 more people would have been screened for colorectal cancer and 50,000 more women would have been screened for breast cancer in 2013. If care is provided to all Californians at the same cost as in San Diego, the cost of care would decrease 10% for commercially enrolled people. Many factors contribute to regional performance, including socioeconomic characteristics and the availability of medical services.

Medicare Advantage
The quality and cost of care varies widely for seniors enrolled in Medicare Advantage. For example, in North Bay counties, 91% of women have gotten appropriate breast cancer screening compared to 70% in the Eastern region 13. The average annual per-enrollee total cost of care for Medicare Advantage enrollees ranges from $11,500 in San Diego County to $14,500 a year in Los Angeles region.

Cost of Care
Geographic variation in cost of care is dramatic—a difference of $1,800 in the average annual per-enrollee total cost of care between the most costly and least costly regions. With one exception, all Northern California regions have higher annual per-enrollee costs than the statewide commercial average of $4,300 while all Southern California regions fall below the statewide average. Central California regions show mixed results on cost. HMOs have a lower average total cost of care than do PPOs in 12 of the 18 regions. More tightly managed care in HMOs may contribute to a lower cost of care. Yet, inpatient bed days and readmission rates are similar for HMOs and PPOs. Emergency department visit rates are actually higher for HMOs. The statewide average annual per-enrollee cost of care for commercially insured Californians is $4,300. Kern County is the least costly HMO region. It’s $1,800 per enrollee, per year less than in Santa Clara County, which is the costliest HMO region. The least costly PPO region is Los Angeles at $2,400 less than San Francisco County, which is the costliest PPO region.

Manufacturing Leads Adoption of High-Deductible Health Plans

Manufacturing

A survey by Benefitfocus reveals distinct differences in benefit offerings among manufacturing, education, and health care industries. Manufacturing leads the adoption of high-deductible health plans (HDHPs), education favors traditional plans (PPOs, HMOs, etc.) and the health care industry offers the most voluntary benefits. Manufacturing is the only industry of the three, in which more companies offer a combination of HDHPs with traditional plans than traditional plans only (48% to 46%). Manufacturing employees selected an HDHP over a traditional plan 46% of the time. The findings suggest that manufacturing employers have an opportunity to encourage employees to participate in health savings accounts (HSAs) or flexible spending accounts (FSAs) to cover higher out-of-pocket costs associated with HDHPs. Only 23% of education employers offer at least one HDHP. Traditional health plans dominate the mix of benefits. HMOs made up 44% of employee enrollments, which suggests an opportunity to offer a wider range of lower cost benefit options for a multi-generational workforce.

Employees in the health care industry face high deductibles regardless of plan selection, but are better equipped to cover unexpected medical costs with voluntary benefits (including critical illness, accident, and hospital-indemnity insurance). Health care employers offered gap products at the highest rate of the three industries at 12 percentage points above the average. Nearly half of health care workers selected a voluntary plan when given the choice.

Medicare Advantage 2016 Spotlight

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The number of Medicare beneficiaries enrolled in Medicare Advantage has climbed steadily over the past decade; this trend in enrollment growth continues in 2016. The enrollment growth has occurred despite provisions under the ACA that reduce payments to plans. As of 2016, the payment reductions have been phased in fully in 78% of counties, accounting for 70% of beneficiaries and 68% of Medicare Advantage enrollees, according to a study by the Kaiser Family Foundation. The following are study highlights:

  • Medicare Advantage enrollment has increased in virtually all states over the past year. Almost one in three people on Medicare (31% or 17.6 million beneficiaries) is enrolled in a Medicare Advantage plan in 2016. The penetration rate exceeds 40% in five states.
  • 18% of enrollees are in a group plan. Employers and their retirees still favor local PPOs over HMOs.
  • Enrollment is still highly concentrated. If Aetna acquired Humana with no divestitures in 2016, the combined firm would account for 25% of Medicare Advantage enrollees nationwide. UnitedHealthcare and Humana account for 39% of enrollment in 2016.
  • Premiums were relatively constant from 2015 to 2016 ($37 a month in 2016 versus $38 a month in 2015), although premiums vary widely across states, counties, and plan types.
  • In 2016, the average enrollee had an out-of-pocket limit of $5,223, which is nearly $1,000 higher than in 2011.
  • 31% of the Medicare population is enrolled in a Medicare Advantage plan. Total Medicare Advantage enrollment grew 5%, from 2015 to 2016. This reflects the influence of seniors aging on to Medicare and beneficiaries shifting from traditional Medicare to Medicare Advantage.
  • 64% of Medicare Advantage enrollees are in HMOs; 23% are in local PPOs; 7% are in regional PPOs; 1% are in private fee-for-service plans; and 4% are in other types of plans including cost plans and Medicare medical savings accounts.
  • Enrollment in private fee-for-service plans has declined slowly since the Medicare Improvements for Patients & Providers Act (MIPPA) of 2008. Under the law, in most parts of the country, private fee-for-service plans must have a provider network. About 1% of Medicare Advantage enrollees are in these plans. 26% of enrollees in private fee-for-service plans are in counties in which private fee-for-service plans are exempt from network requirements.
  • Medicare Advantage enrollment in California grew 6% from 2015 to 2016.
  • 44% of beneficiaries in Los Angeles County, California are enrolled in Medicare Advantage plans compared to only 11% of beneficiaries in Santa Cruz County, California.
  • The average MA prescription drug enrollee pays a monthly premium of about $37, which is 1% less than in 2015. Actual premiums are $28 a month for HMOs, $63 a month for local PPOs, and $76 a month for private fee-for-service plans. Average Medicare Advantage premiums for HMOs and local PPOs have decreased since the ACA was enacted while average premiums have increased for regional PPOs and private fee-for-service plans.
  • In 2016, 81% of Medicare beneficiaries had a choice of at least one zero premium MA prescription drug plan. From 2015 to 2016, the share of enrollees in zero premium MA prescription drug benefits remained relatively unchanged (48% in 2015 versus 49% in 2016). Fifty-nine percent of HMO enrollees are in zero premium plans; 38% are in regional PPOs; and 22% are in local PPOs. No zero premium private fee-for-service plans plans were offered in 2015 or 2016.
  • The average out-of-pocket limit for a MA prescription drug enrollee is $5,223, up from $5,041 in 2015 and $4,313 in 2011. The share of enrollees in plans with limits above $5,000 has greatly increased across all plan types. Fifty-two percent of enrollees are in plans with limits above $5,000 in 2016 compared to 46% in 2015. Thirty-seven percent of enrollees in 2016 are in plans with limits at the $6,700 maximum, compared to 32% in 2015 and 17% in 2011. Ninety-nine percent of regional PPO enrollees and 62% of local PPO enrollees are in plans with limits above $5,000 in 2016. In comparison, 45% of HMO enrollees are in plans with limits above $5,000 in 2016.
  • The standard Medicare Part D plan has a $360 drug deductible and 25% coinsurance up to an initial coverage limit of $3,310. That is followed by a coverage gap (the doughnut hole) in which beneficiaries pay a larger share until their total out-of-pocket Part D spending reaches $4,850. After exceeding this catastrophic threshold, beneficiaries pay 5% of the cost of drugs.
  • 95% of Kaiser Permanente’s enrollees are in HMOs. In contrast, enrollment in UnitedHealthcare and Humana plans is mostly in HMOs, but includes significant shares in local and regional PPOs. Humana’s distribution continues the shift from earlier years when a much larger share of Humana’s enrollees was in private fee-for-service plans plans. Enrollment in BCBS plans is split between HMOs (46%) and local PPOs (41%), with the remainder in regional PPOs and other plan types including private fee-for-service plans plans.
  • Kaiser Permanente’s presence is more geographically focused than other major national employers, with a heavy concentration in California, Colorado, the District of Columbia and Maryland.
  • Medicare Advantage enrollment could become more concentrated if Aetna’s acquisition of Humana and Anthem’s acquisition of Cigna are approved, particularly if few divestitures are required. If no divestitures are required in Aetna’s acquisition of Humana, the combined company would account for 25% of Medicare Advantage enrollment nationwide. UnitedHealthcare accounts for 21% of enrollment this year.
  • The Anthem’s acquisition of Cigna would have a less visible affect on the national Medicare Advantage market. Nationwide, Anthem accounts for 3% of Medicare Advantage enrollment and Cigna accounts for another 3%.
  • For many years, CMS has posted quality ratings for Medicare Advantage plans. In 2016, 68% of plans had four or more stars. In focus groups, seniors have said that they don’t use the star ratings to select a plan. Nonetheless, the star ratings may be correlated with factors that seniors do use to select their plan, including provider networks, and plan benefits and costs, and thus may be correlated with enrollment.
  • The Congressional Budget Office projects that about 41% of Medicare beneficiaries will be enrolled in Medicare Advantage in 2026. This growth may prompt some to question what it will mean if the preponderance of beneficiaries are in Medicare Advantage plans.

Medicare Advantage Versus Traditional Medicare

A report by the Kaiser Family Foundation reveals that Medicare HMOs perform better than traditional Medicare in providing preventive services and using resources more conservatively, at least through 2009. Two studies found that Medicare PPOs performed better than traditional Medicare on some metrics (particularly mammography rates). HMOs performed better than PPOs. These studies were conducted before changes made by the Affordable Care Act (ACA) to improve coverage of preventive services under traditional Medicare.

There is some evidence that relatively low cost-sharing (through Medicare HMOs or through Medicare with supplemental coverage), may result in earlier diagnoses of some cancers compared to traditional Medicare alone. Treatment patterns for some cancers may differ between Medicare HMOs and traditional Medicare, but studies do not show that it affects patient outcomes.

Medicare beneficiaries in HMOs are less likely to be hospitalized for a potentially avoidable admission than beneficiaries in traditional Medicare, according to six studies of beneficiaries represented by the Alliance of Community Health Plans (ACHP). Four of these studies rely on data before 2006, and reflect HMO experiences in mature markets. Performance varies substantially among Medicare Advantage plans, even among those of the same plan type. More established HMOs with integrated delivery systems tend to perform better.

On the other hand, beneficiaries rate traditional Medicare higher in quality and access, such as care and plan rating, though one study suggests that the difference may be narrowing for the average beneficiary. Traditional Medicare is much more popular among beneficiaries who are sick. It is not yet possible to assess performance after the implementation of the ACA’s Medicare Advantage payment changes. Except for hospice care, none of the 40 studies comparing Medicare Advantage to traditional Medicare rely on data from 2010 or later

Insurance Regulation Shifting Toward Managed Care Agency

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by David Gorn www.californiahealthline.org
The regulation of health insurance in California is shifting dramatically toward the Department of Managed Health Care, whose share of the commercial market has mushroomed in recent years. The change has come at the expense of the other agency in the state’s unusual bifurcated system, the California Department of Insurance, whose authority over commercial health plans plummeted from 20% of the market to about 12% between 2012 and 2014 — the most recent data available.

For a variety of reasons, the shrinking of the insurance department’s responsibilities is likely to continue, according to Katherine Wilson, CEO of Wilson Analytics, a health care consulting firm based in San Francisco. “It’s a huge shift, particularly in the individual market,” Wilson said. “And the change in the small-group market is huge too, just not as big.” In 2012, the insurance department regulated 71% of the individual market; by the end of 2014, that figure had plunged to just 18%. California is the only state in the U.S. with dual health insurance regulators.

Critics of the state’s divided approach note that it dilutes regulatory power by giving the insurance companies a wedge between the two agencies and creating needless inefficiencies in health care and how it’s paid for become increasingly complex.

“This dual structure contributes to consumer confusion, government and insurance carrier administrative burdens, and difficulty in monitoring what is being bought and sold in the insurance marketplace,” according to a 2011 paper by the Kelch Policy Group, published by the California Health Care Foundation. It also complicates the taxation of insurance companies: taxes on health plans regulated by the managed care agency are lower in many cases than they’d be if the same health plans were governed by the insurance department — an issue that is wending its way through state courts.

The Department of Insurance, led by Commissioner Dave Jones, has authority over old-fashioned indemnity plans and some PPOs. The managed care agency traditionally regulates HMOs, but recently it has picked up some types of PPOs. That has blurred the regulatory line between the two agencies. Perhaps more important, it has allowed some insurance companies the flexibility to essentially choose their regulator in many cases. That is a contributing factor in the shift of health plan supervision away from the insurance department.

Health insurers have said that consolidating policies under DMHC’s jurisdiction is more about achieving operational efficiencies and that the regulatory requirements are just as rigorous as insurance department rules.

But it’s also the case that some insurers feel uncomfortable with Jones, who is an elected politician with ambitions for higher office and does not shy away from public confrontation with the industry -– though as the data show, his influence over insurance companies is contracting.

Shelley Rouillard, appointed by Gov. Jerry Brown, has been director of the managed-care agency since December 2013. She has pursued several high-profile enforcement cases against health plans, including the failure to provide adequate mental-health treatment and giving patients inaccurate provider directories.

Neither agency, however, has the power to stop insurers from raising premiums, no matter how large the increases. Legislative efforts have been made to change the regulatory structure. Last session, for example, Assembly member Kevin McCarty introduced a bill that would have put all PPO insurance products under purview of the Department of Insurance. That proposal went nowhere, but it is a two-year bill so it could return during the legislative session. More likely, the Department of Managed Health Care will continue to assume a growing regulatory role, Wilson said. Over the years, there have been calls to end California’s bifurcated health insurance regulation, but if the trend continues it may resolve itself, she said. “It would be sort of a de facto single regulator.”

Hospital-Owned Physician Organizations Incur Higher Costs

Hospital-owned physician organizations had higher expenditures for professional, hospital, laboratory, pharmaceutical, and ancillary services for patients in commercial HMOs compared to for patients in physician-owned organizations. The study, published in the Journal of the American Medical Assn., was conducted from 2009 to 2012. Organizations owned by multi-hospital systems incurred 19.8% higher expenditures compated to physician-owned organizations. The largest physician organizations incurred 9.2% higher expenditures per patient than did the smallest organizations. Hospitals are rapidly acquiring medical groups and physician practices. This consolidation could foster cooperation and reduce expenditures. But it could also lead to higher expenditures through greater use of hospital-based ambulatory services and that fact that hospitals will have more pricing leverage against health insurers. Local hospital–owned physician organizations incurred 10.3% higher expenditures per patient than did physician-owned organizations. For more information, visithttp://jama.jamanetwork.com/article.aspx?articleid=1917439

Covered California Announces SHOP Plans

Plans under Covered California’s Small Business Health Options Program (SHOP) now offer more benefit choices and options for adult dental coverage. Employers can offer coverage from two different metal tiers for small businesses starting coverage October 1 or later. The dual metal tiers must be adjoining: Bronze and Silver plans, Silver and Gold plans, or Gold and Platinum plans. Also, alternate benefit designs are being offered through three of SHOP’s carriers: Health Net, Kaiser Permanente, and Western Health Advantage. These alternate benefit designs meet the essential health benefits requirement of the Affordable Care Act, but vary from the standardized benefits established by Covered California. The plans provide expanded employee choice. Also, employers can now offer separate dental plans for adults beginning in 2015. Dental benefits are employee-paid, with no additional cost to employers. The six health plans and 10 dental plans offered through SHOP are a mix of HMOs, PPOs, and exclusive-provider organizations. The health plans are from the following health insurance companies:
• Blue Shield of California
• Chinese Community Health Plan
• Health Net
• Kaiser Permanente
• Sharp Health Plan
• Western Health Advantage

The following are successful bidders for Covered California’s SHOP dental coverage: (Dental Health Services is an additional dental carrier for 2015.)

• Access Dental Plan
• Blue Shield
• Delta Dental
• Dental Health Services
• Guardian
• Liberty Dental
• Managed Dental Care
• MetLife.
• Premier Access.
• Safeguard Health

Businesses are not mandated to enroll in SHOP, and there is no penalty for not participating. California businesses with 50 employees or fewer can choose from quality health insurance plans similar to those available to larger businesses. Businesses with fewer than 25 employees are eligible for tax credits exclusively available through Covered California’s SHOP. Covered California’s SHOP has enrolled 1,714 businesses, which accounts for 11,510 employees and their dependents. Open enrollment for SHOP is available year-round.

Seniors and Persons with Disabilities Are Happy With Managed Care

Beginning in 2011, seniors and persons with disabilities (SPDs) in 16 counties with Medi-Cal fee-for-service had to choose a managed care plan or be assigned to one. Seventy to 80% say that the health services in managed care plans are just as good or better than those from fee-for-service caregivers, according to a survey by University of California, Berkeley. Those who had the most difficult transitions were SPDs who are in the worst health and those with functional and cognitive impairments. People were more likely to experience challenges if they rated their health as poor; had activity and mobility limitations; had difficulty reading health care materials; or were African American, Latino, or older than 65. For more information, visit www.chcf.org.

Consumer-Driven Health Plans Leap Ahead of HMOs

Consumer-driven health plans (CDHPs) have surpassed HMOs to become the second most common plan design offered by U.S. employers, according to a survey from Aon Hewitt.

The 2011 survey of nearly 2,000 U.S. employers reveals that 58% offered a CDHP and 38% offered HMO plans. PPOs continue to be the most widely offered plans, with 79% of employers offering them in 2011.

Among employers that offer CDHPs, health savings accounts (HSAs) outpace health reimbursement arrangements (HRAs) (34% versus 18%). But, 43% of employees enroll in HRAs compared to 28% who enroll in HSAs. This reflects the fact that HRA plan designs are popular among large employers embarking on full replacement CDHP strategies. HRAs offer more design flexibility to the employer compared to HSAs. HSAs typically they generate lower enrollment because they are offered to employees as one of several plan options.

Maureen Fay, senior vice president and head of Aon Hewitt’s CDHP working group said that, despite an increase in prevalence, CDHP enrollment lags behind enrollment in PPO and POS plans. The average enrollment in a PPO plan was 69% in 2011 followed by POS plans (49%). Forty-three percent enrolled in a high-deductible CDHP with an HRA and 28% enrolled in a high-deductible CDHP with an HSA.

Employers are using a variety of tactics to encourage employees to enroll in these plans including subsidizing premiums at a higher level than other plan options (36%), covering preventive medications before the deductible (34%), and contributing employer funds to the HSA (30%) and HRA (22%).

More employers are also considering voluntary/elective benefits to supplement these plans, such as critical illness, hospital indemnity, and accident insurance policies. Twenty-six percent of those using this tactic report a moderate to significant increase in CDHP enrollment because of the availability of voluntary or supplemental medical benefits. While just 6% of employers use voluntary/elective benefits to complement the CDHP and encourage enrollment, 42% report they are considering this approach in the next few years.

A separate survey of 3,000 employees reveals that employees are willing to try CDHPs and their associated accounts. Employees will continue to choose them because they often come with a lower premium. However, employees find them challenging to understand and use.

Joann Hall Swenson of Aon Hewitt said, “Employees want the most cost-effective plan with the least hassle, but they often are not all that interested in digging into the details of CDHPs, HSAs, and HRAs. Our research and experience tells us that simply giving employees lots of educational information about these plans and accounts is only helpful to the small minority of people who like all the details.” To address this challenge, Aon suggests the following:

• Get the right people into the right plan. Employers need to identify the segments of their population that are most likely to sign up for a CDHP and then tailor the marketing campaign to them. They also need to monitor employees’ experience with the plan to ensure it re-sells itself and encourages consumers to have appropriate health and financial behaviors.
• Explain how employees can benefit from the plan’s key features. They also need to tell employees what very specific about the actions consumers need to take.
• Make it easy for employees and their families to use the plan. This includes removing barriers to care through initiatives like value-based plan designs or full funding of employer contributions to HSA/HRA accounts at the beginning of the year.
• Navigate new tools to help employees select appropriate treatments and providers based on available cost and quality information.
• Offer activities, such as biometric screenings and health risk assessments, to help employees assess their health opportunities and risks.
• Use resources, like health coaches and disease management nurses, to help employees meet their goals of health improvement and maintenance.
• Follow preventive care guidelines.
• Manage chronic conditions by working closely with the employee’s physician and adhering to evidence-based treatment protocols.

For more information, visit www.aonhewitt.com.

Last Updated 11/18/2020

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