Posts Tagged ‘Jay Lowe’

Are We Beginning To See Price Transparency In Healthcare?

Tuesday, May 19th, 2015

The post below is a guest blog from Jay Lowe who serves as Principal, Health & Welfare Consultant for CAI’s employee benefits partner Hill, Chesson & Woody.

healthcare costsAs pricing in the healthcare market continues to rise, we, as consumers of this healthcare, will begin seeking more cost-efficient ways to pay for this. Many experts agree that one way to begin to slow this rise is to become smarter with our healthcare buying decisions. A ‘smart healthcare consumer’ is one who seeks out the highest quality of care at the lowest price and understands the impact of their healthcare buying decisions.

One of the major hurdles to this is the lack of understanding on where to find information. In areas where there is a lot of competition for healthcare, costs can vary for the same procedure at different facilities. However, based on one’s medical plan, the cost to the patient may be the same by the time the deductible and coinsurance limits are met. The patient doesn’t realize there is a cost difference because his or her out-of-pocket expenses remain the same. It is the insurance company that is ultimately paying the difference, which causes potential increases to premiums at the next renewal.

This disconnect of the user of the healthcare (the patient) and the payer of the healthcare (the insurance company) is beginning to shrink as we see a shift to more consumer-driven health plans like high deductible plans and HSA-qualified plans. More of the actual charges are now being paid by the member on these types of plans. Due to this, the demand for greater pricing transparency is increasing.

We are now beginning to see the marketplace respond as third party companies are unveiling new technology designed to give us more precise information on the cost and quality of the services we seek. The Milkin Institute School of Public Health points to a number of new resources designed to give consumers cost information. Additionally, the health insurance carriers are redesigning their cost comparison tools on their member websites. Just recently, Blue Cross Blue Shield of NC introduced a new pricing tool that integrates the member’s underlying health plan to show actual out-of-pocket cost for procedures at different facilities. This gives members a true shopping experience when seeking care.

Some carriers have developed phone apps that compare expenses and outcomes for many services and procedures, allowing consumers to find healthcare providers, urgent care centers, and emergency facilities, as well as average costs for medical services.

Ultimately, we will be able to evaluate our healthcare costs quickly and easily. It will be our responsibility as consumers to use this information efficiently and hopefully make an impact to our premiums.

Are We Beginning To See Price Transparency In Healthcare?

Thursday, April 16th, 2015

The post below is a guest blog from Jay Lowe who serves as Principal, Health & Welfare Consultant for CAI’s employee benefits partner Hill, Chesson & Woody.

healthcare transparencyAs pricing in the healthcare market continues to rise, we, as consumers of this healthcare, will begin seeking more cost-efficient ways to pay for this. Many experts agree that one way to begin to slow this rise is to become smarter with our healthcare buying decisions. A ‘smart healthcare consumer’ is one who seeks out the highest quality of care at the lowest price and understands the impact of their healthcare buying decisions.

One of the major hurdles to this is the lack of understanding on where to find information. In areas where there is a lot of competition for healthcare, costs can vary for the same procedure at different facilities. However, based on one’s medical plan, the cost to the patient may be the same by the time the deductible and coinsurance limits are met. The patient doesn’t realize there is a cost difference because his or her out-of-pocket expenses remain the same. It is the insurance company that is ultimately paying the difference, which causes potential increases to premiums at the next renewal.

This disconnect of the user of the healthcare (the patient) and the payer of the healthcare (the insurance company) is beginning to shrink as we see a shift to more consumer-driven health plans like high deductible plans and HSA-qualified plans. More of the actual charges are now being paid by the member on these types of plans. Due to this, the demand for greater pricing transparency is increasing.

We are now beginning to see the marketplace respond as third party companies are unveiling new technology designed to give us more precise information on the cost and quality of the services we seek. The Milkin Institute School of Public Health points to a number of new resources designed to give consumers cost information. Additionally, the health insurance carriers are redesigning their cost comparison tools on their member websites. Just recently, Blue Cross Blue Shield of NC introduced a new pricing tool that integrates the member’s underlying health plan to show actual out-of-pocket cost for procedures at different facilities. This gives members a true shopping experience when seeking care.

Some carriers have developed phone apps that compare expenses and outcomes for many services and procedures, allowing consumers to find healthcare providers, urgent care centers, and emergency facilities, as well as average costs for medical services.

Ultimately, we will be able to evaluate our healthcare costs quickly and easily. It will be our responsibility as consumers to use this information efficiently and hopefully make an impact to our premiums.

How Can Staffing Firms Manage The Employer Mandate?

Thursday, October 16th, 2014

The post below is a guest blog from Jay Lowe who serves as Principal, Health & Welfare Consultant for CAI’s employee benefits partner Hill, Chesson & Woody.

hcw 10 16 14Be sure your staffing firm is ready to be part of the solution, not part of the problem.

Many companies use staffing firms to fill placement needs within their organizations. The placements can be for short-term coverage needs or longer term work assignments. Under the Employer Mandate portion of the Patient Protection and Affordable Care Act (PPACA), these temporary employees must be classified just as any other permanent employee based on their job description or role within the company. The classification determines whether or not this temporary employee should be offered health coverage. Improper classification and failure to offer health coverage to a full-time but temporary employee could result in significant tax penalties levied against the client employer.

The Problem

When PPACA was initially enacted, the rules around staffing firms were not clearly defined. There was some speculation that these entities would not be subject to the Employer Mandate or penalties and that companies who use staffing agencies would not be required to offer their ”staffed” or “temporary” employees coverage. Earlier in 2014, however, the IRS and the Department of Labor issued clarification around this and deemed that the Common Law Employer is to be responsible for providing coverage to staffed employees and will receive the penalty if out of compliance with the Employer Mandate.

The Common Law Employer may or may not be the staffing agency and is to be determined using the IRS 20 factor test. This determination would be made regardless of any agreement or contract between the staffing agency and the client employer. Additionally, the issuing company of an employee’s Form W-2 is not determinative of who is responsible for offering coverage. In many cases, the Common Law Employer is the client employer who receives the temporary employees from the staffing firm. When the client employer is the Common Law Employer, the burden of offering coverage (and the risk of penalty) lies with the client employer.

The Solution

The Employer Mandate final rules provide some relief to companies using staffing firms, by allowing a staffing firm to make an offer of coverage on behalf of the Common Law Employer. A compliant offer of coverage for staffed employees releases the Common Law Employer (i.e., the client employer) of the Employer Mandate obligations for those employees procured through the staffing agency. The rules around this are simple:

  1. First, the offer of coverage must be made by the staffing firm. The coverage will consist of a medical plan that meets or exceeds the 60% actuarial value limit set by law and be affordable to the employee (total annual premium cost to the employee of no more than 9.5% of their W-2 income).
  2. Second, the plan that is offered is a group health plan established or maintained by the staffing firm.
  3. Third, the fee paid to the staffing firm by the client employer is higher for those temporary staffers who enroll in the plan than it is for those temporary staffers who choose not to enroll. Basically, the staffing company is required to pass along a portion of the cost of insurance to their client employer.

What should you do now?

Employers who use temporary employees should ask their staffing firms questions about how they are complying with the PPACA regulations, as that could have a significant impact if penalties are triggered. Conversely, staffing firms must be prepared to answer the questions they will receive from their clients.

Questions that should be asked and answered are:

  1. How do you plan to comply with PPACA in 2015?
  2. Do you plan to offer MEC to full‐time employees?
  3. Will the MEC be of minimum value (i.e., 60% plan value)?
  4. Will you be charging a different fee for employees enrolled in the plan than for employees not enrolled in the plan?
  5. If yes, what will the differential be?
  6. Will you obtain and maintain waivers for those employees who waive coverage?

Ultimately, there is a vital necessity for any company that uses temporary employees to have an open channel of communication with their staffing firm. Employers must educate their staffing firms on types of employees they need with respect to their classification. Conversely, staffing firms must educate their employer clients on how they plan to manage the Employer Mandate and what to expect regarding pricing and coverage on the employees they place. Staffing firms and their employer clients must work together to develop a plan to reduce and/or eliminate the exposure to penalties.

Private Exchanges Are Here – Now What?

Tuesday, September 16th, 2014

The post below is a guest blog from Jay Lowe who serves as Principal, Health & Welfare Consultant for CAI’s employee benefits partnerHill, Chesson & Woody.

hcw 9 12 14By now you have probably heard the term “Private Exchange.” Private exchanges are the hot new topic in the benefits world and something that employers should become familiar with as it may be an option to consider in the future. Private exchanges are nothing new. In fact, they have been around for about 20 years but without the fancy title.

The creation of the federal and state-based exchanges, where individuals can buy their own insurance, has brought new life back to the private exchange idea. Under this model, an employer is able to offer an à la carte selection of benefits for their employees to choose from. All of this is managed through a Human Resources Information System (HRIS) during annual open enrollment, or at the time of hire, and streamlines the administration process for the employer.

With the re-emergence of the private exchanges we will begin to see the shift to a true defined benefit strategy from employers who implement this. Heath Insurance Underwriter indicates that in order for private exchanges to be successful, they must find ways to continue to be competitive. This is especially good news for small employers (under 50 employees) as options are reduced and premiums begin to rise. In a recent New York Times article, Accenture predicts that by 2018 enrollment through private exchanges will surpass that of the state and federal exchanges. However, this will come at a cost. Benefits in the private exchanges are expected to become leaner as companies try to stay within budgets.

What’s important to understand is that this is not a new concept, just a re-branding of an old idea. Private exchanges are risk pools that should be considered just like any other risk pool: weighing out the pros and cons for your organization. As we move forward into the post-Reform world, we will continue to see new players enter the marketplace with their own versions of private exchanges. There is good news, though. The market is evolving under Reform to meet the needs of employers.

 

Considering Voluntary Benefit Offerings As Part Of An Employee Benefits Package

Tuesday, June 18th, 2013

The post below is a guest blog from Jay Lowe, who serves as Principal, Health & Welfare Consultant for CAI’s employee benefits partner, HCW Employee Benefit Services.

Blog 015 PictureAs the cost of providing benefits to employees continues to rise, an often underappreciated benefit employers can offer at little expense is voluntary benefits. These include such products as life insurance, dental insurance, critical illness insurance, vision benefit, disability income replacement coverage, and home owners/rental and auto insurance.

 

Voluntary benefits allow an employer to maintain a robust offering of services that enhances the overall package, while letting workers handle the total cost of benefits through their payroll deductions.

 

With voluntary benefits, employers can set themselves apart from competitors that offer only the traditional lines of medical coverage. Since many workers have indicated through several surveys (including some cited below) that they want a suite of benefits, voluntary benefits should be a popular item to implement. This can ease employees’ worries relating to future costs that may be incurred in these areas and shows them the value of their employment, thus serving as a strong retention tool.

 

The annual “Study of Employee Benefits Trends” white paper released by MetLife this year suggests that many employers nonetheless are failing to recognize the appeal of voluntary benefits and take advantage of them. With the exception of 20 percent who offered life insurance, at most only 10 percent of businesses with up to 499 employees surveyed offered any other voluntary benefits. At the same time, at least 26 percent of Baby Boomers and 38 percent of younger workers (Gen X and Y) said they were interested in each of those products even though they had to pay 100 percent of the cost.

 

The white paper reported that 38 percent of workers surveyed cited a choice of voluntary benefits as a factor that drives loyalty to their company. More than 50 percent of both younger workers and Baby Boomers said they would rather pay for benefits than lose them. The white paper noted that “Voluntary benefits … can serve to fill gaps and supplement employer-paid programs to provide a more holistic benefits offering.”

 

Another recent survey by Guardian Research discovered that participation rates in voluntary benefits have been climbing and will continue to increase, especially for non-dental and non-vision offerings. The study said that addressing the lack of perceived need for voluntary benefits has been and will continue to be the biggest opportunity moving forward for employers in this area.

 

These findings suggest adding voluntary benefits can be part of an effective employee recruitment strategy for employers, but several considerations need to occur for successful implementation. One is the wide variety of products available. Beside the voluntary benefits listed in the white paper, employers can provide additional lines such as supplemental life and dependent life, critical illness coverage, cancer coverage and hospitalization. Should any or all of these benefits be included in your package?

 

healthcare_industry_issuesAnother concern is making sure employees understand what the benefits involve. Employees frequently overlook voluntary benefit offerings during orientation and open enrollment because they are focusing on other tasks they consider more important, such as adjustments to their existing plans. If employees concentrate on other items than voluntary benefits when they are presented, chances are strong they will avoid taking full advantage of the products and programs. The time and money spent on presenting such benefits to employees will have been a waste for the employer.

 

When selected and presented properly, voluntary benefits are a great way for employers to enhance their traditional lines of coverage at little or no cost to the company’s bottom line. There are convenient, web-based enrollment tools which provide a simple, quicker enrollment and reduce costs and free up time to focus on running the business in the process. The process serves as an effective recruitment and retention tool in attracting and maintaining top talent in the organization.

 

From an employee perspective, the ease of purchasing these types of products via payroll deduction can be a great benefit. The simplicity of accessing this protection at the workplace avoids wasted time by the employee looking for this coverage during their free time.

 

Employers should be cautious and limit the lines of coverage when initially launching these benefits.  Gauge employees’ interest in the proposed products before deciding what coverage to offer. Employees who believe programs are of limited value in what they can buy likely will not participate in them. Identify employee needs and interests, and match product options to them to produce better results. Involvement in voluntary benefits is particularly crucial for smaller employers, as minimum participation percentages or signup of enrollees may be required in order for the plan to take effect.

 

It’s important to consider your communication methods around these benefits as well. For effective communication of voluntary benefits, provide information beyond orientation and open enrollment sessions. Send out emails, put up flyers, devote special meetings to provide an overview and answer questions. Talk about the voluntary benefits year round. Help employees fully understand and appreciate what voluntary benefits do for them and how they are relevant.

 

One final key consideration is making sure that any voluntary benefit offering supports and integrates with the core health and welfare strategy. This is another area where HCW consultants assist in ensuring alignment with your organization’s entire benefit strategy.