next-gen aca: how to do more than just comply with the affordable care act

1 © 2015 Benefi+ocus.com, Inc. All Rights Reserved | Confiden@al & Proprietary

Next-‐Gen ACA: How to Do More Than Just Comply with the Affordable Care Act Jeremy Mar@n

© 2015 Benefi+ocus.com, Inc. All Rights Reserved | Confiden@al & Proprietary 2

Forward-‐Looking Statement This presenta@on may include forward-‐looking statements related to the future business and financial performance of Benefi+ocus and future events or developments involving Benefi+ocus. These statements may be iden@fied by words such as “expects,” “looks forward to,” “an@cipates,” “intends,” “plans,” “believes,” “seeks,” “es@mates,” “may,” “might,” “will,” “could,” “would,” “should,” “targets,” “projects” or words of similar meaning. Forward-‐looking statements can involve a number of risks and uncertain@es that could cause actual results to differ materially from those explicit or implicit in the forward-‐looking statements, including fluctua@ons in those results, general economic risks, management of growth, the need to innovate and deliver useful products and services, our ability to compete effec@vely, reliance on key personnel, privacy, security, regulatory changes, and other risks associated with our business as set forth from @me to @me in our filings with the SEC. Some of the products and/or product features discussed in this presenta@on may be works in progress and not yet generally available for sale. Benefi+ocus assumes no obliga@on and does not intend to update any forward-‐looking statements.


ACA – The Law of the Land The steady drumbeat of change

Summary of Benefits & Coverage (SBC)

Employer Repor@ng

Employee Opt-‐Out Survey

Grandfathered Plans

Dependent Eligibility

Employee No@fica@ons for State Exchanges

Employer Shared Responsibility and Look-‐Back Calcula@on

Reduced Wait Periods

Pre-‐Exis@ng Condi@ons

Auto-‐Enrollment


The GOP Controls Both the Senate and House •  House has already passed a bill that would change employee eligibility from 30 hours to 40 hours

•  Difficulty in the Senate bringing S.30 to a vote

•  President expected to veto it


SCOTUS will hear King vs. Burwell


We’re in the Post-‐ACA World

SO WHAT…

We can’t take our eyes off the ball


Cost containment

Communica@ng the value of the benefits program

Consumer Choice

Compliance

System moderniza@on to support changing strategies

Measurement and data driven insights

Interoperability among business partners

What did companies need? Prior to ACA What did companies need?


We’re in the Post-‐ACA World Now. . .

•  Lookback •  IRS Repor@ng

–  Forms 1095-‐A, 1095-‐B, 1095-‐C –  W2

•  Strategy for managing Excise Tax risk

•  January 1, 2015 data capture start •  First quarter 2016 to have repor@ng to IRS

•  IRS will honor “reasonable efforts,” but that has not been defined as yet

WHAT employers need WHEN they need it


We’re in the Post-‐ACA World

Cost containment

Communica@ng the value of the benefits program

Consumer Choice

Compliance

System moderniza@on to support changing strategies

Measurement and data driven insights

Interoperability among business partners

What do companies need now?


Never let a good crisis go to waste.

How can we leverage ACA to accomplish our strategic goals?

Ambiguity within the legislature does not impact your needs!

© 2015 Benefi+ocus.com, Inc. All Rights Reserved | Confiden@al & Proprietary 11 11

Fall 2014 Wellness Pre-‐qualifying ques@ons

Fall 2015 OE One CDHP, Plan Shopping with Member Claims Data, Complimentary Voluntary Benefit products

Fall 2016 OE Mul@ple CDHP Plans, Plan Shopping, Wellness Enrollment Alignment, VB

Fall 2017 OE Full Replacement CDHP with VB

Avoiding the Excise Tax – Sample Glide Path to 2018

Excise Tax in Effect


Communica@ng Plan Design Changes

© 2015 Benefi+ocus.com, Inc. All Rights Reserved | Confiden@al & Proprietary 13 13

Fall 2014 Introducing the basics.

Fall 2015 OE Establishing the value of the HSA. Mi@ga@ng the Deduc@ble Gap risk.

Fall 2016 OE Introducing long-‐term thinking around the HSA savings. Providing tools for protec@ng your balance.

Fall 2017 OE Gaining control over your spend, focusing on your goals.

Glide path toward consumerism


ACA -‐ Silver Linings for Consumer Choice •  Passive Enrollments = Passive

Consumers •  Cri@cal to leverage an ac@ve

enrollment •  Key @me to introducing cost and

consumer educa@on tools

•  Ongoing engagement with your wellness strategy

•  Understand the goals of the individual •  Leverage the Ac@ve Enrollment to clean up data


ACA Silver Linings for Communica@ng the Value of Benefit Programs

•  Are people really in the right plan? •  We can analyze aggregate and individual data

•  COMPARE THIS YEAR to LAST YEAR –  Communica@ng the consequence of not

making a decision –  Overlay that default plan to your

previous claims data -‐ Is this bad or good?

–  At the individual level, we can overlay that informa@on – “Here’s what it means to default” as a marke@ng message

Auto Enrollment


You Own the Message

•  Communica@on and Culture are linked –  This is a touch point; make about culture.

•  Ongoing engagement in cost decisions •  OE is the opportunity to assert the value of your benefits

–  “Certain requirements can’t be altered. Here’s how we’re taking these requirements and provide the best benefits available to associates.”


You own the message. . .

It’s important to get the message right the first @me.

It’s difficult to change the ini@al impression of a plan change.

Don’t Poison the Well!


Welcoming the newly eligible!

•  You have their ear -‐ maybe for the first @me -‐ so what do you do with it? •  Opportunity to engage on more than benefits

–  Confirming W2 informa@on –  Electronic paycheck presentment –  Touch point for encouraging direct deposit or a payroll card –  Capture compliance documenta@on

•  Restric@ng access to enrollment un@l to-‐do list is completed

New FTEs


Data Driven Insights


ACA Silver Linings for Cost Containment

Leveraging claims data to truly bend the cost curve •  Risks of broad based wellness ini@a@ves •  Targeted disease management to move the cost needle •  Data available to both consumer and employer •  Workers Comp Repor@ng

Data AnalyAcs -‐ Wellness



•  Compensa@on Analysis –  Iden@fying trends –  Appropriate compensa@on by posi@on –  Underpaid High Performing Associates

•  Recrui@ng –  Predic@ve Analy@cs around hiring for seasonal labor –  Internal Mobility Trends –  Turnover –  Turnover Cause Analysis

Lookback Data



•  Employee Engagement –  How are hiring and Turnover trends impacted by plan changes?

•  Re@rement Eligibility

•  Risk Mi@ga@on –  EEOC –  401k Non-‐Discrimina@on Tes@ng

Lookback Data


–Rebecca Costa, author, The Watchman’s RaIle

In the scien@fic study of ecosystems, the key lesson is that when there is a change to the environment, you either evolve or you die.


Silver Linings – Technology Strategies

•  Technology needs to be able to adapt to shius in market, and your pla+orm should not determine your strategy.

•  Find technology that does more than meet the lever of compliance. –  How does this enable your strategic goals?

•  Considera@on of non-‐tradi@onal ways to cover employees. •  Affordable Care Act has opened the door to considering new technology, and new models for delivering benefits. Necessity is the mother of inven@on.

Flexibility is key


Flexibility and Interoperability are the New Baseline

•  Single-‐source systems are slow to adapt

•  “Everything to everyone” is not an executable strategy

•  Walled gardens wither; community gardens flourish


Key Takeaways 1.  ACA is an impetus for change, leverage this “crisis” to achieve larger

strategic goals.

2.  In the big picture of cost and employee engagement strategy, how much does regulatory ambiguity maver?

3.  Leverage change to create educated benefits consumers.

4.  Drive greater insight from data gathered for repor@ng.

5.  Beware of “walled gardens”.

next-gen aca: how to do more than just comply with the affordable care act

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