Академический Документы
Профессиональный Документы
Культура Документы
Presented to
Favorable
ACA signed into law on March 23, 2010
Unfavorable
Dont know/Refused
60%
46%
48% 44%
50% 45%
50%
48%
46%
40%
40%
41%
41% 35%
43%
40%
42%
40%
41%
43%
42%
20%
14%
14% 10%
14%
12%
15% 11%
18%
18% 13% 9% 8%
0%
Mar
Apr
May
Jun
Jul
Aug
2010
Sep
Oct
Nov
Dec
Jan
Feb
2011
Mar
This information was reprinted with permission from the Henry J. Kaiser Family Foundation. The Kaiser Family Foundation is a non-profit private operating foundation, based in Menlo Park, California, dedicated to producing and communicating the best possible analysis and information on health issues.
Guaranteed issue Financial help for low and moderate income Americans in need of coverage Increase Medicare payroll tax on wealthy
Individual mandate
Note: Question responses abbreviated. See Topline: http://www.kff.org/kaiserpolls/8166.cfm for complete wording. Keep it but make changes (vol.) and Dont know/Refused answers not shown. This information was reprinted with permission from the Henry J. Kaiser Family Foundation. The Kaiser Family Foundation is a non-profit private operating foundation, based in Menlo Park, Source: Kaiser Family Foundation Health Tracking Poll (conducted March 8-13, 2011) California, dedicated to producing and communicating the best possible analysis and information
on health issues.
Alignment
Employer Sponsors Administrative Complexity New choices Financial Strain
Fees and Taxes Insurance Prices Business Administration Costs
2012
Final Federal Regulation Expected Final Confirmation of Exchange Readiness
2013
2014
Market Activities
Effective Date
Open Enrollment
Enabling Legislation
All plans will fall into a classification system of metal tiers The Exchange will present significant challenges
What is the Exchange? Who can participate? When will it start? Who operates the Exchange?
It is a new, highly regulated retail distribution channel that creates a transparent and competitive administrative mechanism for individual and small-group enrollment Individuals and small businesses with 1-100 employees. Prior to 2016, states may define small employer as 1-50 employees.
State Exchanges operated by government or nonprofits; states may form regional exchanges or allow more than one exchange (no overlapping geographies)
10
Insurers cannot medically 5 underwrite or apply preexisting condition clauses Price parity required if 6 same product sold on and off exchange
Insurers must offer at least 3 one Silver and one Gold product Restricted rating factors to 4 Age, Smoking, Geography and Family Status
The Exchange is introducing a new system of classifying health plans. The new labels are called metal tiers, and they correspond to the actuarial value of the plan.
14
Premium tax credits and cost-sharing subsidies are available, but there are rules Tax credits can pay for a portion of the plan premium for those
who are eligible
Premium tax credits are available depending on income levels Subsidies cover a portion of out-of-pocket costs, depending on
income levels
15
FPL: Federal Poverty Level; Medicaid eligibility is generally extended to 133 percent FPL calculated with a 5 percent income disregard. Thus, Medicaid eligibility is effectively up to 138 percent FPL
*There are situations in which an individual with less than 138% FPL could be eligible such as legal immigrants who are not yet eligible for Medicaid.
16
Employees can only access premium tax credit on the exchange if:
OR
The employee share of premium cost exceeds 9.5 percent of the employees household income The employer provided coverage does not pay for 60 percent of the expected essential benefit costs. (does not have at least a 60% actuarial value)
FPL
FPL
138-200%* 200-300%
*There are situations in which an individual with less than 138% FPL could be eligible such as legal immigrants who are not yet eligible for Medicaid.
18
FPL: Federal Poverty Level; Medicaid eligibility is generally extended to 133 percent FPL calculated with a 5 percent income disregard. Thus, Medicaid eligibility is effectively up to 138 percent FPL
19
20
Employers may elect to not offer coverage Applicable large employers that do not offer benefits may pay
an excise tax
21
Excise tax
Excise tax
This information was reprinted with permission from the Henry J. Kaiser Family Foundation. The Kaiser Family Foundation is a non-profit private operating foundation, based in Menlo Park, California, dedicated to producing and communicating the best possible analysis and information on health issues.
22
1
Employers that do not offer minimum essential coverage, and have at least one full-time employee that receives a premium tax credit on the exchange: Excise tax = $2,000 X (# of full-time employees 30 employees)
2
Employers that offer minimum essential coverage and have at least one fulltime employee that receives a premium tax credit on the exchange. The excise tax is the lesser of: $3,000 for each full-time employee receiving a tax credit OR $2,000 for each full-time employee 30 employees
23
24
There are many new responsibilities for employers, but we are here to help Regulations will pose new administrative challenges for
employers
25
W-2 Health plan cost reporting Include womens preventive services for
plan years after Aug 1
26
FSA cap of $2,500 Medicare payroll tax rate increase for high income Inform high income employees of Medicare payroll and investment income taxes Must notify people of the Exchange
Communicate reform changes to all employees Large employers must offer sufficient coverage or be subject to penalty Some large employers must autoenroll employees in a health plan Small employers should determine whether to shop on an Exchange Remove waiting periods in excess of 90 days
27
28
There are several new taxes and fees, but some are more significant than others
Plans with extremely rich benefits may fall under the new
Cadillac tax
29
Cadillac Tax
30
Health FSA cap Prescriptions required for HSAs, HRAs and FSAs Branded drug market share tax
2011
Medical device tax Increase Medicare payroll tax rate for high-income earners
01/01/13
31
OR
32
33
ACA requires plans to adhere to certain MLR thresholds Large and small group MLR requirements differ New MLR rules require extra data collection and also require
that rebates be provided if thresholds arent met
34
85%
80%
If an insurance issuer does not meet these ratios, it must provide rebates to its members to meet the threshold.
35
36
37
Reform may change how providers behave and how they are
structured
Regulation encourages providers to consolidate Groups of providers operate differently than solo practitioners
38
Structural changes
39
Obligations Controls
Shared Savings
ACOs have their choice of two risk tracks in the first year: Amount of shared savings/losses depend on performance on quality measures and lowering cost ACOs may be eligible for higher shared savings depending on percent of beneficiaries visiting FQHCs/RHCs. CMS will withhold 25% of shared savings until completion of 3 year performance period
40
OSCs
Measure performance
Coordinate care
42
New rules give consumers many more options Regulation may also change what market employers belong to The face of the insurance market will likely change drastically
43
Medicaid expansion Subsidies for individuals Insurance reforms Penalties for not having or offering Medicare fee-for-service payment changes Health insurance exchanges Funding (fees and taxes)
44
What will the effects on the market be? Pressure on employer-group coverage Increased individual market Downward pressure on payments to hospital and physicians Price competition and benefit standardization Administrative complexity and compliance risks
Market shift
45
Group sponsor challenges and decline in group coverage Individual and consumer market growth Financial challenges for provider community Price sensitivity and potential commoditization Administrative complexity and compliance risks New category of disruptive competitors
7 10 12
4
8 10
21 7
75
12
2010
2016
SOURCE: BCBSA Strategy Collaborative; Moodys Economy.com; Michigan Dynamic Coverage Model; Census; McKinsey analysis; and State Health Facts Database
46
47
BCBSM has many new tools designed to help customers through these changes BCBSM will help employers craft their benefit strategy through
Health Care Path ForwardSM
48
Health Care Path Forward is employer-specific analytics designed to help employers understand and craft their benefits strategy
2011 Deliverables in Process 2012 Deliverables
Michigan Employer Health Care Reform Analysis
These materials are for informational purposes only and not for the purpose of providing legal, actuarial, accounting or other advice. The information in this document is based on BCBSMs and BCNs current understanding of the Patient Protection and Affordable Care Act, Pubic Law No: 111-148 (ACA); however, interpretations of ACA vary and the federal government continues to issue guidance on how it should be interpreted and applied. Although we strive to ensure our information is accurate and useful, you should contact your attorney or other consultants to obtain advice on the impact of various reforms on your individual situation and professional assurance that our information, and your interpretation of it, is appropriate to your particular issue or problem.
49
How will the Reform Action Guide and the analytics work?
Each employer will be assessed by our analytics model and assigned a Reform Strategy Profile
Profile A
Reform Subsidy Penalties
>
Likely to Maintain Benefits Sponsor Role and strategically adopt plan innovations Likely to Continue Some Form of Benefits Sponsorship and take immediate steps to ensure affordability
Profile B
Profile C
<
These profiles will be articulated with employer-specific financials that highlight the most relevant available strategy paths into 2014 schedule a discussion with your account manager.
These materials are for informational purposes only and not for the purpose of providing legal, actuarial, accounting or other advice. The information in this document is based on BCBSMs and BCNs current understanding of the Patient Protection and Affordable Care Act, Pubic Law No: 111-148 (ACA); however, interpretations of ACA vary and the federal government continues to issue guidance on how it should be interpreted and applied. Although we strive to ensure our information is accurate and useful, you should contact your attorney or other consultants to obtain advice on the impact of various reforms on your individual situation and professional assurance that our information, and your interpretation of it, is appropriate to your particular issue or problem.
50
What is GlidePath ?
SM
A defined-contribution model with flexibility, freedom and support for your members.
51
Bloom Health is a separate company that provides decision making support for employees and a defined contribution framework for Blue Cross Blue Shield of Michigans GlidePath solution
52
Based in Minneapolis, Bloom Health helps employers of all sizes and industries better define and control their health care spending. Bloom then guides employees through the complex world of health insurance, helping them find the right health plan for them and their families with its proprietary search and recommendations engine.
Bloom Health was founded in 2009. Bloom Health is partially owned by the Blue Cross Blue Shield Venture Partners, L.P., a corporate venture fund sponsored by Blue Cross Blue Shield Association. For more information, visit www.gobloomhealth.com.
Bloom Health is a separate company that provides decision making support for employees and a defined contribution framework for Blue Cross Blue Shield of Michigans GlidePath solution
53
Encourage Primary Care Access Financial Incentives and Disincentives (Non-ACO/OSC) Build Stronger Referral Relationships Comprehensive Preventive Care within OSC Value-Based Design (Essential Medications)
Manage health care quality Manage cost Improve the health of our members
Wellness Incentives
BCBSMs future product design will align with the OSC network model and goals:
Questions?
Baby Boomers
1946 1964
Gen X
1965 1980
Gen Y
1980 - 1994
W ORKFORCE
D EMOGRAPHICS
Todays Workforce
Great Generation Baby Boomers Gen X Gen Y
T HE Q UESTION I SN T
Question IS
What you don't want is to offer a good benefit program, only to have employees perceive that the company is providing it reluctantly.
The messages must express a real concern for and commitment to employees and their families.
#3 Increased competition for jobs, markets and talent #6 Large numbers of baby boomers (1945-1964) leaving the workforce at about the same time
J OB S ATISFACTION E LEMENTS
62%: Job Security 60%: Opportunities to use Skills/Abilities 60%: Compensation / Pay 59%: Relationship with Immediate Supervisor 53%: Benefits
Two thirds or 53% of employed adults are open to a new job or actively looking for a new job!
Based on U.S. Census Bureau 2010 data
T HE T IE
TO
TALENT
N O O NE L IKES C HANGE
But A Wet Baby!
Q UESTIONS ??
Nancy McKeague Michigan Health & Hospital Association Julie Mann JMann Consulting Group The Rock Star Factory