How to “Survive” the Future of Health Care

blog imageBy Lesa Caputo, Benefit Advisor
Beneflex Insurance Services, A UBA Partner Firm

The number of people affected by the recent onslaught of natural disasters such as tornados, fires and earthquakes are too many to count. These events cause one to reflect and ask questions like, “What would I do in the same situation?”, “What should I be doing right now to prepare for a similar event?” or “What can I do to help others and myself recover and rebuild?”

Without sounding too catastrophic, planning to survive and ideally, thrive in the future of health care in the United States is an eventuality that consumers, providers, insurance companies, employers and brokers all must embrace. However, we can and should be doing so with an attitude of confidence, a plentitude of resources and open minds to new ways of delivering, receiving and financing health care.

Our current U.S. health care system has remained virtually unchanged since the introduction of Medicare in the mid-1960s, when it was approved by Congress. However, the extraordinary complexity and fierce economic trajectory of our health care delivery system has managed to catapult itself forward, despite a framework that is static, outdated and unsustainable. While not trying to sound too melodramatic, we have indeed arrived at the brink of “natural disaster.”

However, as the saying goes, when a door closes, a window opens. As such, adversity breeds creativity and we are seeing new reimbursement and delivery models such as accountable care organizations (ACOs) and other patient centered outcome based models emerging.    

Physicians, hospitals and all medical providers will become more actively engaged in the delivery of care, which creates exciting opportunities to improve quality, while more effectively managing health care costs. And the requirement among health care providers to migrate to a paperless electronic medical record (EMR) also presents ways to avert medical errors, better manage the overall health of an individual and improve communication between all parties.

Further, health insurers are entertaining private exchange models to create “mini-pools” where risk can be more accurately predicted and managed to the benefit of stretching the premium dollar.

Stop loss carriers, also known as self-insurance companies, are opening their doors to smaller employers as a way to increase the size of their overall risk pool. By doing so, these carriers are providing employers with transparency into the health risks prevalent among their own insured population and the opportunity to offer incentive-based wellness programs to encourage employees and their dependents to improve their health status.

Last, but certainly not least, UBA Partner Firms representing employee benefit agencies across the country are working to innovate and develop the best tools, solutions and decision making guides to assist employers before, during and after this “storm.”

Starting in October 2013, employers will be faced with the latest onslaught of PPACA requirements and will need representation that is informed, proactive and directly involved. 

  • On Oct. 1, 2013, employers will be required to provide their employees with a written notice about ACA Exchanges. The Department of Labor recently released the model notices for employers to use.  The “Employer Exchange Notice to Employees” requires some customization and is anticipated to be a significant area of focus as part of future routine DOL audits. The UBA PPACA Advisor reference tool, available to UBA Partner Firms clients, provides critical model documents as they are released by the DHHS and DOL.
  • Starting in January 2014, the ACA requires Applicable Large Employers (companies that employed an average of 50 or more full-time or full-time equivalent employees in 2013) to offer affordable health coverage to full-time employees or potentially face a penalty. The penalty results when a full-time employee receives federally subsidized coverage from their state exchange, due to a lack of health coverage that meets federal standards for affordability and value. UBA Partner Firms’ clients will benefit from the ACA modeling software tools that calculate the costs associated with the different options that may result from the Pay or Play requirement.
  • Beginning in 2014, large employers must file a return to the Internal Revenue Service (IRS) that reports the terms and conditions of the healthcare coverage provided to their full-time employees for the calendar year. The returns for 2014 will be filed in 2015. This new tax reporting requirement will just further add to the list of “disaster readiness” that employers are accumulating.

The response, or preferably the preparation, from employers bracing for this additional workload, should be to demand the most value for their dollar. Whether that dollar be in the form of premiums paid to a fully insured carrier, claims reimbursed for a self-funded plan or compensation paid to their advisor for guidance and outside-the-box support, employers have something to leverage and that is choice. There is strength in having a plan, executing it successfully and preparing for the worst, but always aiming for the best!