Health Care Reform and Chambers
21
2013 ACCE Convention Health Care Reform and Chambers
description
Health Care Reform and Chambers. Agenda. PPACA overview: How did we get here? PPACA impact on Chambers Key considerations for the evaluation of your program Opportunities to be a resource to your members Resources. Health Insurance History - Marketplace. Premium Prices Soar - PowerPoint PPT Presentation
Transcript of Health Care Reform and Chambers
2013 ACCE Convention
Health Care Reform and Chambers
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Agenda• PPACA overview: How did we get here?• PPACA impact on Chambers • Key considerations for the evaluation of
your program• Opportunities to be a resource to your
members• Resources
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Health Insurance History - MarketplacePremium Prices Soar
Average Premium per Year
Employer Health Benefits 2011 Summary of Findings, The Kaiser Family Foundation
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Health Insurance History - Marketplace
Firm Size 99 00 01 02 03 04 05 06 07 08 09 10 11
3 – 9 56% 57% 58% 58% 55% 52% 47% 48% 45% 49% 46% 59% 48%
10-24 74% 80
% 77% 70% 76% 74% 72% 73% 76% 78% 72% 76% 71%
25-49 88% 91
% 90% 87% 84% 87% 87% 87% 83% 90% 87% 92% 85%
Percentage of Firms Offering Health Benefits by Firm Size
Employer Health Benefits 2011 Summary of Findings, The Kaiser Family Foundation
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Market Structure Changes
New Insurance
Rules
Individual Mandate
Employer Mandate
Health Insurance Exchange
Optional Medicaid Expansion
• Medical Loss Ratio• Guaranteed issue/renewability• Essential benefits• New fees and taxes
• Small Business tax credits• Pay or play for 50+• Grandfathering• Delayed until 2015
• Premium tax credits• Individual penalty• Max deductibles
and out of pockets
• Public federal and state exchanges
• SHOP Exchanges
• System volume—provider taxes
• Cost shift for low wage employees
• Getting federal “share”
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What does this mean for your Chamber and the support you
provide to your members?
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Where can you make a difference in small group? Distribution costs (brokers, marketing)
Premium tax – 1.4%
Profit control
Administrative costs (communication, retention, churn)
Benefit Design
Cost of claims
Wellness
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Health care reform challenges the viability of today’s chamber programs• Reform requirement to move from experience rating and unique
program pool factors to community rating
• Requirement that all small businesses within a carrier’s book of business are rated on same factors
• Compression of distribution costs to meet new Medical Loss Ratio requirements pressuring margin and marketing expense
• Creation of new distribution infrastructure including Health Insurance Exchanges, Navigators and Co-ops
• Under 10 life market – potentially large part of chamber member pools – movement to public exchanges and individual market due to subsidies
• Long term nature of broker driven business and need for unique delivery of value added support
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What should you be considering as you think about your Chamber’s role in health insurance?
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Chambers need to consider the role they want to play among the continuum of options.
No Role/ Exit
Value added Service Provider
NavigatorGroup
Purchaser/ Captive Agent
Multi Line Brokerage PHIX COOP
Continuum of Roles
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Market Structure Changes
Health Insurance Exchange
Individuals Self-EmployedSmall Employers
(2-100)
Medical Mutual Anthem Kaiser
New Health Care Co-op “National” Plan
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Being a key part of the distribution channel is also a possibility Advertising and sponsorship revenue streams on a non-exclusive basis
Endorsement of a particular carrier
Endorsement by or inclusion of the chamber in a private health insurance exchange environment
Beyond health insurance, positioning the chamber to endorse or participate in related distribution opportunities
Insurance as the starting point or potential “loss leader”
Other options pitched as a part of the connection to the employer exploiting the relationship and moving related product to employees
Broker and alliance roles
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Feeding the strategy machine…What are you
providing that is unique and valuable?
How does that work relate to your mission?
In its best possible, achievable
outcome, what will work in this area do
to advance the mission?
What resources are required to
achieve success and staying
power?
How critical is the impact you can make for your
members relative to other
alternatives?
What political implications exist for
the role you are considering in your
environment?
How will your actions impact
relationships with key employers,
providers, industry players and
stakeholders in your community?
How does the potential business model support or conspire against the needs of your
members?
Does advocating for your business
model put you in conflict with the
goals of your members or your
mission?
How does the work you do stack
up against your members
expectations?
What alternatives exist for use of
resources (staff, money, brand, relationship, goodwill) to
advance results for your members?
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Ideas for action…
Things You Should Definitely do…
Things you might consider…
Higher risk opportunities for
mission or sustainability
• Honor and acknowledge the relationship, trust and brand you have with business community decision makers
• Education of members
• Advocacy / information for legislative process and rulemaking
• Research/info gathering on attitudes, behaviors, impact, expectations
• Provide advertising opportunities and venues for players looking at market share
• Consultative support at the next level for members (calculators, tool sets, technical sessions)
• Exchange outreach/ navigator role
• Endorsement of insurance provider or ancillary benefit strategies (carrier, exchange, tpa)
• Brokering help among members
• Exchange operator
• COOP or self insurance pools
• Deeper involvement in case client health outcomes management
• Aggressive support of new market entrants or tests
• Government contracts funded by PPACA
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Three key areas of potential discussion with your leadership
Understand the urgency of your situation – can you afford to “wait and see?”
Understand the practicality of your options – relationships, stakeholders, short term opportunities and long term risks
Look “outside” for ideas but decide based on the unique issues you face “inside” your situation
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Your Chamber’s “End Game”
Best in the
WorldPassionate
Resource Engine
Best in the WorldWhat can your chamber be the best in the world at doing in support of your members?
PassionateWhat is your organization passionate about?
Resource EngineWhat drives the economic engine of your organization? For your chamber, what drives the goodwill of your members?
So, how does health insurance fit for you?
Framework from Jim Collins, Good to Great and the Social Sectors
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How can you be a help your members as they prepare for the implementation of PPACA?
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Provide information and education
Market reform overview and timeline; COSE GamePlans
Informational web sites; collaboration point
Webinars on aspects of market change
Broker/legal/financial adviser panel presentation
Review sessions/help line staffed by brokers
Calculators and estimators; tax credits, FTE, pay or play
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Advocate for business Clarity of rules
Transparency
Access / availability of information
Flexibility for the market to work
Maintain / create incentive for employer action and involvement
Minimize penalty for reaction to business realities
Focus the conversation away from financing mechanisms (insurance) and towards cost and quality among providers and health and wellness
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Resources• www.cose.org/healthcarereform • COSE Health Care Gameplan• Kaiser Family Foundation (www.kff.org)
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Questions?• Steve Millard, COSE
• 216-592-2436 or [email protected]• Kenn Penn, ChamberSolutions
• 757-664-2502 or [email protected]
