Seminar Presentation - Lynnwood - Capital Benefit...This presentation is intended solely as a general overview of the subjects discussed. It is not an exhaustive review of federal

WELCOME!

Innovation

Transparency Cost reduction

Engagement

ConsumerConsumer

PARTNERSHIP

TransparencyConsumer

You paid how much?

Employer Solutions

The ultimate health care shopping solution

Delivering the leading transparency platform to health plans for over 8 years.

Offers configurable healthcare shopping experiences for health plans & employers

Enables making smarter choices around choosing providers and treatments based on cost, quality, convenience, and social

Serving over 65 Health Plans and their employer clients that cover 100+ million members

is a portfolio company of

Cambia Health Solutions

Employer Solutions 30

We are spending too much on healthcare

31Employer Solutions

Affordable care options exist todayShoulder arthroscopy

In Dallas

$3,000to

$26,000

In Dallas

$3,000to

$26,000

In Seattle

$2,000 to

$18,000

In Seattle

$2,000 to

$18,000

In Boston

$4,000 to

$22,000

In Boston

$4,000 to

$22,000


50%

Lower Cost

High

er Q

ualit

y A

dhe

renc

e

No correlation between cost and quality

web-based tools

But where can we go for answers?


wellness initiatives

health assessment

DM programs

GENERIC PHOTO

NO PRICES AVAILABLEDON’T KNOW IF IT’S IN STOCK

YOU CAN’T

BUY THIS HERE.

CALL 555-5555

NOTHING TO SEE HEREWE DON’T HAVE ANY SUGGESTIONS


Are we ready for Health-azon?

Regence’s availableshopping solutions



Understand your options from a high level


Compare options from a detailed level

Provider A

Provider B

Provider C

Provider D


Our shopping tools are informing decisions…

Gallbladder Removal

Inpatient Outpatient Surgical

$19,102 $11,107 $6,360

Cost Estimator users choose

Non-users choose

Average Cost

Least expensiveMost expensive

41% 55%

10% 70% 20%

4%

(2 year period of regional health plan’s claims history)

Inpatient Outpatient Surgical

$19,102 $11,107 $6,360Average Cost

Least expensiveMost expensive

$10,319Average Cost for Cost Estimator users

$14,195Average Cost for Non-users

Gallbladder Removal

(2 year period of regional health plan’s claims history)


Informed decisions drive cost savings


Partnering with HealthSparq on customized employer engagement solutions


How can we engage consumers?

Proactive campaigns

Foundational work

Conveniences

Opportunity analysis

Targeted promotions

Concierge line

Microsite access

Personalized alerts

Telehealth

Our integrated solution

Employer Solutions 44

Employer customized buy-up (250+ ee)

Powered by HealthSparq

On Regence.comtoday (all members)

Powered by HealthSparq

Transparency tools that enable smarter decisions

• Single Search• Real Prices• Patient Ratings and

Reviews• Health and Wellness

Community

Customized strategy to truly engage employees

• Analysis and Engagement Services

• Additional ways to access information

• Proactive Campaigns• Conveniences

www.healthsparq.com

@HealthSparq


Thank you!

Cost Reduction Consumer

Accountable Care Organization (ACO) Evolution

PPO

Benefits

Cost

2014 2015

ACO

CURRENTLY COMING SOON

ACO Product Evolution

PPO

Benefits

Cost

2015 2018

ACO

ACO

ACO

ACO

ACO

ACO

INNOVATION Consumer

Affordable Care Act Implementation Update

Presentation to Master Builder’s AssociationSeptember 30, 2014

Chris Bandoli

Director, Government Affairs

Regence BlueShield

© 2014 Regence BlueShield44

Disclaimer

This presentation is intended solely as a general overview of the subjects discussed. It is not an exhaustive review of federal or state requirements, and nothing in this presentation should be considered to be or relied upon as legal or financial advice

The materials and discussion represent the presenter’s understanding of current federal and state requirements, which are subject to change at any time and may be subject to differing interpretations

While the information provided is believed to be accurate, it should not be relied upon as a substitute for independent research and consultation with legal and other experts

45 © 2014 Regence BlueShield

How it was supposed to work in 2014

Expanded CoverageIndividual Insurance

• Guaranteed Issue

• Coverage Mandate

• Tax Credits & Subsidies

• Exchanges for competition

Employer Coverage• Penalties for not

offering coverage

• Small Employer

Tax Credit

Medicaid ExpansionEveryone up to 133% FPL

46 © 2014 Regence BlueShield

2014 - Medicaid

June 2012: U.S. Supreme Court ruled states can’t be forced to expand Medicaid by threat to withhold all Medicaid funds

Washington expanded Medicaid in 2013 legislative session

Enrollment: Approximately 300,000 newly eligible adults

© 2014. Regence BlueShield of Idaho, all rights reserved. 47 © 2014 Regence BlueShield

2014 – Individuals & Small Employers

“You can can’t might be able to keep your current plan.”• Administration announced in late 2013 that, at the discretion of the states,

renewals of non-ACA compliant plans will be permitted through Oct. 1, 2016 for individuals and small employers

• Washington said “no”

• Commissioner Kreidler anticipated around 290,000 cancellations at the end of 2013

• Still a possibility of offering extension to 51-99 size groups in 2016, pending OIC decision…

© 2014. Regence BlueShield of Idaho, all rights reserved. 48

X X

© 2014 Regence BlueShield

2014 – Individuals

No changes to penalty provisions

Need to be aware of open enrollment period and special enrollment opportunities

Open enrollment for 2015 will run November 15, 2014 to February 15, 2015

© 2013. Regence BlueShield of Idaho, all rights reserved..49 © 2014 Regence BlueShield

2014 - Exchanges

Washington Health Benefit Exchange – “Healthplanfinder” – among most successful state exchanges in the nation

Enrollment: Approximately 170,000

Issues

• Initial/special enrollment

• “Aggregating” premiums

Budget

• HBE wants $19 million increase in 2015

• Additional dollars would be funded by assessment on plans sold in Exchange


2014 – Large Employers

July 2, 2013: Treasury announces no employer penalties for 2014

February 10, 2014: Treasury releases final employer shared responsibility rule and fact sheet announcing more “transitional relief”

• Employers with less than 100 employees get additional year delay

• Employers with 100+ get some relief as well

Treasury Fact Sheet: http://www.treasury.gov/press-center/press-

releases/Documents/Fact%20Sheet%20021014.pdf

On July 24, 2014 the Internal Revenue Service released drafts of the forms that individuals, insurers, and employers will use for reporting information to the IRS necessary for reconciliation of premium tax credits and for the enforcement of the individual and employer mandate programs


2014 in summary . . .

Expanded CoverageIndividual Insurance

• Guaranteed Issue

• Coverage Mandate

• Tax Credits &

Subsidies

• Exchanges for

competition

Employer Coverage• Penalties for not

offering coverage

• Small Employer

Tax Credit

Medicaid ExpansionEveryone up to 133% FPL


Looking Ahead: Employers must know FTEs

53

Number of Full Time Employees working 30+ hours per week for the month

(or at least 130 Hours during the Month)

Full Time Equivalents: Add all hours in the month for part-time employees, then divide by 120 hours

+ = FTEs for the Month

ThenTotal all FTEs for all months for the year and divide

by 12 to get average FTE per month = <50 = Small50-99 = Mid

100+ = Large

Note: Employers may be able to use six months rather than full year for initial FTE determination

© 2014 Regence BlueShield

2015: Mid-Sized Employers (51-99 FTEs)

Employer penalty will not apply until 2016

• Employer must certify it meets eligibility requirements on form prescribed by Treasury

Required to provide coverage to at least 95% of full-time employees in 2016 or pay a shared responsibility penalty

Non-calendar year plans have until renewal in 2016 to come into compliance

Look-back measurement period will be in 2015


2015: Large Employers (100 or more FTEs)

Employer penalty will apply in 2015

Non-calendar year plans can wait until 2015 renewal to come into compliance

Required to provide coverage to at least 70% of full-time employees for 2015 and 95% of full-time employees for 2016

Dependent Coverage requirement will not apply in 2015 to large employers that are taking steps to arrange for dependent coverage in 2016

Look-back Measurement Period in 2014 (6 months OK)


Association Health Plans

ACA regulations mandate that association plans be “bona fide”

• Bona fide = certain ERISA and HIPAA standards

OIC enforcing “bona fide” standards upon renewal of the association master contract in 2014

• Regence Non-Bona Fide AHPs: NET, EST, WBACC

• Regence Bona Fide AHPs: MBA/BIAW, NMTA, WTIA, WFB, Vigilant, WAIA

© 2013. Regence BlueShield of Idaho, all rights reserved. Private and confidential.56 © 2014 Regence BlueShield

2014 State Legislative & Regulatory Action

Regulatory

• Network Access rules

• Mental Health rules

• Filing standardization rules

• Transgender exclusions ban

Legislative

• Innovation Plan

• Grace Periods

• Prior Authorization

© 2013. Regence BlueShield of Idaho, all rights reserved. Private and confidential.57 © 2014 Regence BlueShield

© 2014 Regence BlueShield 58

QUESTIONS?

INNOVATION Consumer

Retiree Plans for Medicare eligiblesEmployer Group Waiver Plans

What’s in your wallet?

Regence MedAdvantage

What is an Employer Group Waiver Plan (EGWP) Program?

An exclusive group Medicare option available to retired employees of members of the Master Builders

Access to enhanced benefits

More flexible enrollment times than traditional Medicare timeframes

Regence MedAdvantageRegence Medicare Group Retiree Plans

Medicare Group Retiree Plans are health plans offered through Centers for Medicare & Medicaid Services (CMS) and administered by Regence.

Easy to administer, they help minimize your exposure and accounting obligations for your retired employees and protect your business against cost fluctuations, providing a fully insured solution that ensures less disruption and greater satisfaction for your retirees.

Regence MedAdvantage

Potential for lower costs

Medicare Group Retiree Plans offer lower-cost coverage that can result in lower contributions for retirees.

You can typically pay lower rates with a group retiree plan. Plus, they give you improved predictability of costs without significantly increasing retiree contributions.

Regence MedAdvantage PPO plan

Freedom to use your own doctor and hospital

No referrals to see specialists

Large provider and pharmacy network

Lowest cost sharing in-network

Still covered out-of-network with slightly higher cost sharing, depending on your plan choice

Worldwide Coverage including Worldwide Emergency Coverage

Where you get in-network vs. out-of-network coverage

<service area map>

Nurse Advice Line – 24 hours a day

Round the clock answers from a registered nurse

Call anytime, from anywhere

Case and Condition Management

Nurse case management support for serious illness or catastrophic injury

Disease management for help managing chronic conditions

SilverSneakers®

• Tools to achieve your health and fitness goals

• Access to over 245 fitness locations

• Use fitness equipment, pools and saunas*

• Take SilverSneakers classes*

Find your nearest location at:www.silversneakers.com

*Amenities vary by location

Value Added Service: TruHearing® Hearing Aid Program

Pharmacy Network*Large national network

Local and national pharmacies

Costco, Fred Meyer, Walgreens, Rite-Aid, Safeway, Wal-Mart and more!

Fill prescriptions while traveling at any network pharmacy

Convenient mail-order options and 90 day retain pharmacy options save you time and money

* United States and territories only

EligibilityRetiree Members and their spouses1. Must be entitled to Medicare benefits under Part A and

enrolled in Part B

2. Must be retired, not active

3. Can live anywhere in U.S., not in territories

4. Medicare-eligible spouse of an active employee is eligible too!

5. Cannot live outside of the U.S. for more than 12 months at a time


QUESTIONS?

ENGAGEMENT Consumer

Regence VitalityImproving Employee Health and Productivity

81Regence BlueShield serves select counties in the state of Washingtonand is an Independent Licensee of the Blue Cross and Blue Shield Association

Michael Cochran, Director of WellnessRegence BlueShield

Presentation Objectives

The Health & Wellness Opportunity

Business Imperative for Health

Our Focus and Objectives

Regence’s Integrated Solution

Next-Gen Wellness Solution


Health of the US: Cause


1 in 5

1 in 5

1 in 4

Health of the US: Effect


2 in 3

7 in 10

2 in 5

7 in 10

Health Care Premiums Outpace Worker’s Earnings and Inflation


131%

191%

72%

127%

212%

17%

38%54%

13%28%

43%

0%

50%

100%

150%

200%

250%

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Health Insurance PremiumsWorkers' Contribution to PremiumsWorkers' EarningsOverall Inflation

SOURCE: Kaiser/HRET Survey of Employer‐Sponsored Health Benefits, 1999‐2014. Bureau of Labor Statistics, Consumer Price Index, U.S. City Average of Annual Inflation (April to April), 1999‐2014; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey, 1999‐2014 (April to April).

Economic Rational for Worksite Health


Source: Goetzel, JOEM, (2004) data adjusted to 2010 by Mercer Employer Survey Results and by Collins Presenteeism study (2005) of Dow Chemical that was used for determining the Presenteeism cost.

Health & Wellness: The Business Imperative

Health is a total business issue which affects financial performance• Companies with “highly effective” worksite programs are 40% more

likely to report financial performance above their peers

Employers understand the value of health and well-being programs to their overall organizational health strategy • Seventy percent of companies are developing a workplace culture

where employees are responsible for their health, and understand its importance as a top priority of their health and productivity program

2013/14 Staying@Work Report; TowersWatson/National Business Group on Health


For employers to remain financially competitive, it is imperative they effectively manage rising health care costs


1% 4% 2% 4% 4%9%

14% 15%20% 24%

24%21%

29%26%

27%

32%

41% 32%33%

37%

35%

20% 22% 17%8%

0%

20%

40%

60%

80%

100%

Wellness Programs Consumer‐DrivenHealth Plans

(Ex: High‐DeductiblePlan Combined with aHealth Savings Account)

Disease ManagementPrograms

Higher Employee CostSharing

Tighter Managed CareRestrictions

Don’t Know Not At All Effective Not Too Effective Somewhat Effective Very Effective

SOURCE: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2013

Effectiveness of Strategies to Contain Health Costs

Worksite Programs: Components for Success

Culture of Health

Leadership

Strategy

Engagement Communications

Role Models

Evaluation


Regence Wellness: Our Focus

Our Focus:Maximize employee health and productivity

Our Objectives:


• Provide personalized solutions that meet employees where they are at• Leverage innovative technologies to drive engagement• Utilize the latest in behavioral economics theory and incentive plan design

Increase Engagement

• Establish a “Culture of Health” within the workplace• Provide tools and resources to enable employees to achieve optimal health• Integrate with Regence Care Management programs and other assets

Improve Health

• Focus on Value on Investment (VOI)• Measure the impact on both health and productivity• Move employees from higher risk to lower risk

Bend the Cost Curve

Regence Vitality: A Solution & Differentiator


Not just another product but a solution to improve the health and productivity of your workforce

AnalyticsOur analytic solutions provide you with actionable recommendations,

targeted interventions, and the means to measure outcomes

The Power of RegenceIntegration with the Regence portfolio provides innovative

solutions that can be tailored to meet the needs of your company

ConsultingOur consultants help develop your

strategy, provide fresh ideas to maintain your program, and

establish measures of success

Health CoachingOur health coaches provide your employees with the guidance and

tools necessary to produce measurable behavior change

Solutions to create a “Culture

of Health”

Comprehensive Online Wellness Dashboard


Personalized list of online programs

Rewards tracker with summary of activities

Health Coach only available to Vitality members

One Click to GHA

Health Coaching: Opt-In / Opt-Out Models


Next-Gen Wellness: An Integrated Solution


Web Platform (table stakes)

“Boots On the

Ground” (differentiator)

Next-Gen Wellness

Web Platform for WellnessComprehensive on-line wellness capabilities

Integrated with Regence.com

Flexible incentive and challenge platforms

“Boots on the Ground”Dedicated Wellness Consultants

Regence-employed Health Coaches

Event support (health fairs, webinars)

Communications support

Robust reporting

Next-Generation WellnessA comprehensive health and productivity solution

Distinct wellness packages

Next-Gen Wellness: Meet Customer’s Where They Are At



QUESTIONS?

THANK YOU