Summary of The Alliance

Employer Benefits Roundtable

December 1, 2015

Table of Contents Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Steerage and Medical Tourism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Value-based Insurance Design VBID/Wellness . . . . . . . . . . . . . . . . . . . 9

Telehealth/telemedicine and Onsite Clinics . . . . . . . . . . . . . . . . . . . . . . 14

Consumer-directed Health Plans and the Excise Tax . . . . . . . . . . . . . . 21

Prescription Medications Including Rx and Specialty Rx Tiers . . . . . . 27

Searching for more information on benefit plan design? . . . . . . . . . . 33

Introduction On December 1, 2015, approximately 60 employers, agents and industry professionals gathered at Monona Terrace to

discuss hot topics in benefit plan design.

Staff members from The Alliance facilitated 10 small group discussions and attendees shared their best practices,

concerns and questions. Following the small group discussions, highlights were shared with the larger group.

This event was the first roundtable discussion facilitated by The Alliance. The report is a synopsis of the notes gathered

from this event.

Five topics were discussed: steerage & medical tourism, value-based insurance design (VBID)/wellness,

telehealth/telemedicine & onsite clinics, consumer-directed health plans & the Excise Tax and prescription medications

including Rx & specialty Rx tiers. Each of the five topics discussed has been given a section, as noted in the table of

contents.

All of the notes generated for a topic were used to create the word cloud at the beginning of each section. The more

frequent a word appeared in the notes, the larger the size of the word in the word cloud. The word cloud is followed by

the discussion questions given to event attendees. Each section concludes with a synopsis of the notes generated

from the selected topic.

3

Steerage & Medical Tourism

4

Steerage & Medical Tourism What incentives does your company use to steer employees to specific health care providers

for specific services?

> Most, but not all of the employers represented at the roundtable discussion offer

steerage and medical tourism incentives.

> Examples of incentives based on steerage at the

point-of-decision.

MRI/diagnostic (incentive offered to employees to go to highest

quality/lowest cost providers) [Noted by four groups.]

Through QualityPath and promoting consumerism to steer toward

the highest quality/lowest cost providers

Having lab work done at a contracted laboratory facility instead of

at a hospital

Contracted providers for selected high-value procedures

(QualityPath program and other employer-sponsored programs)

Offer gift cards or offer no co-pay for prescriptions

> Employers want to learn more about steerage options

This topic is still very new to employers – would like more

education on this topic.

Need more information on plan design for steerage and

medical tourism.

Would like The Alliance to offer more steerage programs/expand

QualityPath

> Examples of incentives

based on steerage plan

design.

Offer services at preventive

service rates

Only use positive incentives

Increased employer

contributions $

Offer a contracted service for

second opinions

Steer toward your local area

and share the savings with your

employees

Offer $1,000 gift card incentive

Continued coverage for

complications

Medical tourism to providers

outside the United States

5

Steerage & Medical Tourism What barriers have you encountered when considering or implementing a steerage program?

> Employee barriers

Lack of consumer “caring” to participate

Challenges in communicating programs

effectively to employees

Limited time to spend educating

employees/consumers. Only have one hour

annually (open enrollment) to talk about

steerage. Explaining what is medical

consumerism and why it is important, takes 45

minutes of that hour.

Employees want to stay local for procedures.

Many are not comfortable with going to an

unfamiliar health care system.

Common for employees to want to keep

existing relationships with providers and not

transfer to a new one.

Employees are wary of medical steerage

directly from their employer. Medical steerage

requests mined from medical data, such as

patients with an osteoarthritis diagnosis, are

more favorably received by employees when

sent by The Alliance.

> Geographic location barriers

Employees are hesitant to travel out of their

regional area for health care. They typically

prefer to stay locally. [Noted by four groups.]

Employers and employees prefer to stay with

local providers. [Noted by several groups.]

Geography. Employees living outside of the

primary Alliance network. Employer’s

insurance contains multiple provider networks.

Want to support the local economy. And

employers want the local economy to support

them too.

> Coordination barriers

Complexity

Steerage at the correct time (point of decision)

Doctors sometimes discourage seeking other

medical providers outside of a doctor’s own

network.

6

Steerage & Medical Tourism Does your company offer a medical tourism option? If so, are your employees using it?

Why or why not?

> Many of the employers noted that they are enrolled in QualityPath

> Some employers have steerage programs to their own onsite clinics or specified

local providers

> One employer noted a medical tourism program they sponsored in Mexico

> Some employers noted that they do not currently sponsor steerage or medical

tourism programs

7

Steerage & Medical Tourism

Synopsis

> What kinds of incentives do you use?

Incentives based on steerage plan design

Incentives based on point-of-decision steerage

> What kinds of barriers have you encountered?

Employee barriers

Geographic location barriers

Coordination barriers

> Medical tourism examples.

Onsite clinics

QualityPath

One example of an international medical tourism

program in Mexico.

> Employers asked to learn more about

steerage & medical tourism and how to

better promote these programs to employees.

8

How do your health care benefits compare?

Contact Member Services at mms@the-alliance.org or 800.223.4139 to request a benefits and coverage analysis report customized to your industry, geographic location or company size. A free benefit of your membership with The Alliance.

Value-based Insurance Design VBID/Wellness

9

Value-based Insurance Design VBID/Wellness If your company is using value-based insurance design (VBID), briefly describe what you’re

doing. (VBID is defined as differential coverage for evidence-based treatments and services

and/or steerage to high-value providers.)

> VBID is primarily used for

disease management

Individuals with multiple

health factors are identified

as potentials for company-

designed VBID coverage

Use to manage chronic

conditions

Use to steer to local hospital

No cost sharing for

maintenance meds/chronic

conditions

Disease management

program = free/low-cost

prescription medications

Value-based care for chronic

conditions – based on

population’s need –

preventative maintenance

rather than expensive crises.

> Wellness programs include …

Biometric screenings tied to premium reduction. [Noted by three groups.]

Wellness programs are becoming more outcomes-based

Offer $ for wellness participation, health status

No monetary incentive. Individual health coaching.

Workplace wellness champions

Activity-based wellness

Farm to table incentive

> VBID/wellness insights

Most of the employers at the roundtable event have some type of

VBID/wellness program integrated into their plan, but not all. Many are

struggling to make VBID work most effectively for their population.

Need clear communications/education to explain why VBID/wellness is

beneficial.

Employees can lose sight of benefit when it is monthly reduction in

premiums. Consider cash.

How to best integrate VBID/wellness for the entire family? Spouses can

sometimes be the most expensive on plan.

10

Value-based Insurance Design VBID/Wellness How do you think VBID could help your company manage chronic conditions?

> Weight loss

> Early detection from regular physicals

> Company/culture sponsorship

> Provide a consistent message/plan

> Proper incentives

> Self-funded realizes largest gains

> Adherence to meds

> Increased engagement & Rx compliance

> Incentives increase participation

> Educate/early identification

> Cost savings, but difficult to quantify the ROI

> Healthier workforce – reduced absenteeism

> One-on-one nurse available for

personal education

> Onsite options work well

> Providing incentives for employees to

use quality providers at a good price

> Increase employee health

> Outcome-based to increase productivity

> Steer employees and inform them of

resources for their chronic conditions

> Encourage employee to look at other

resources too (community services)

> Discount, don’t increase cost

> Should be voluntary

> Designed for employees and spouses

11

Value-based Insurance Design VBID/Wellness What are the barriers to VBID/Wellness adoption at your company?

> Education of employees,

leadership team or both

Education to employer & employee

Not at right time

Employer lack of understanding

what does it look like/new concept

Education “too much info” (EE)

Adherence

Lack of buy in from the company

and employees

Difficult to convince leadership

EEOC, Communication, employee

buy-in

Employees think you are getting

too involved in their health care

“Big brother”

Perception of being singled out.

> Employee motivation

People don’t want to be told what they should do or not

do to be healthy = “pay me and I will contribute”

People don’t want you involved. Heath care is personal.

Tied to their PCP

Personal issues

Motivation

> Complexity of program

Overwhelming number of options with limited resources

and time

Incentives are more complex with HDHP.

High turnover employers

Multiple locations & consistency

> Medical Costs

Rapid changes in costs

ROI calculations

12

Synopsis

> How are employers using value-based insurance design

(VBID)/wellness?

Used primarily for disease management.

Wellness programs can include a variety of options, but biometric screenings

are the most popular.

Most of the employers noted that they have a VBID program in place,

but are struggling to make VBID more effective for their population.

> How could VBID help your company manage chronic conditions?

Give incentives for participation

Early identification before problems become chronic

Education/communication to explain what the terms VBID and wellness mean

and why they are important

Emphasis on evolving VBID offerings to be “outcomes-based”.

> What are the barriers to VBID/wellness adoption at your company?

Education of employees, leadership team or both

Employee motivation

Complexity of program

Medical costs

Value-based Insurance Design VBID/Wellness

How do your health care benefits compare?

Contact Member Services at mms@the-alliance.org or 800.223.4139 to request a benefits and coverage analysis report customized to your industry, geographic location or company size. A free benefit of your membership with The Alliance.

13

Telehealth/Telemedicine & Onsite Clinics

14

Telehealth/Telemedicine & Onsite Clinics How do you offer telehealth/telemedicine and/or onsite clinics to your employees?

> Company A covers telemedicine at 100%, they use Teladoc and love it.

> Company B does not currently offer telemedicine, but is looking into it. They tried to obtain

telemedicine through their nurse practitioners via their onsite clinics, but ran into licensing issues

between states. However, they do offer virtual visits through their onsite clinics.

> Company C offers telemedicine consultations for a $5 co-pay, 24/7, no limit on number of visits,

and payment is made by credit card.

> Agent A has a client that uses telehealth: $20 co-pay and an annual limit of three visits.

> Company D uses Amwell for telehealth services.

> Company E uses Virtualwell for telehealth services.

> Company F offers telemedicine visits using Amwell for a $5 co-pay.

> Company G uses a nurse helpline through their pre-authorization company.

> Company H offers health coaching outreach to patients with high-cost potential.

> Company I uses Teladoc and United Health Care for telemedicine visits (via phone or video) for a

$10 co-pay. They have also added a behavioral health option to their telemedicine plan.

> Company J uses a nurse line and Teladoc

> Company K currently has a nurse line. They cancelled Teladoc due to low participation rate.

> In 2015, 11 percent of Alliance members offered onsite clinics.

15

Telehealth/Telemedicine & Onsite Clinics What kinds of benefits are there to offering telehealth/telemedicine and/or onsite clinic options?

> Convenience/efficient use of resources

No driving to doctor’s office

Better access to health care, especially in rural areas

Avoid urgent care/ER visits – avoid long waits for patients

> Lower cost for both employees and employers

> Reducing the barrier of waiting time and/or appointments empowers employees to talk to a primary care provider

sooner. Otherwise they may defer making an appointment and a small problem turns into a big problem – with big

medical bills.

> Save time and money

> Reduced absences

Reduced sick days/PTO

> ROI

Increase health plan quality

16

Telehealth/Telemedicine & Onsite Clinics What kinds of challenges do you see to offering telehealth/telemedicine

and/or onsite clinic options?

> Patient experience

PCP Relationship

Loss of personalization with doctor

Consistent medical staff, turnover and people management

Skeptical of true evaluation of symptoms

Overall understanding of medical analysis

Several times resulted in additional doctor visits

> Plan design/location

Disease management

Fill gaps

Choice

Better in a larger metropolitan area

Conflict with steerage to clinic

> Cost

Initial investment/cost

Bending to the trend of costs

No differential in cost

17

Telehealth/Telemedicine & Onsite Clinics Tell us about your onsite clinic?

> Company A offers an onsite clinic at all of their locations. The clinics are only open

for selected hours, this is their way to get employees in. (Getting people enrolled is

hard due to a generational gap.)

> Many employees at company B do not have a Primary Care Provider. This is

thought to be why company B has seen such success with their onsite clinics.

They allow all employees, spouses and dependents (8 to 26 years old) to access

the onsite clinics. They do this to increase utilization to show their c-suite that

people are using it. (You have to have insurance to use the clinic, not necessarily

through the employer. And all services at this clinic are at no cost.)

> Company C would like to create an onsite clinic.

> Reasons why we do not have an onsite clinic

Population too small. We can’t afford an onsite clinic.

Too difficult to offer an onsite clinic with hours available to all shifts at all locations.

Costs and liability issues are too high.

Cost to build an onsite clinic would be higher than the savings.

Not sure about short-term and long-term ROI. 18

Telehealth/Telemedicine & Onsite Clinics How likely are you to offer telehealth/telemedicine and/or onsite clinic options within the

next two years.

1 of 3 Approximately one of three

roundtable attendees …

• Currently offer telehealth/telemedicine and/or an onsite clinic or are highly considering adding this to their plan design.

• Are somewhat interested in adding telehealth/telemedicine and/or an onsite clinic to their plan design.

• Have low or no interest in adding telehealth/telemedicine and/or an onsite clinic to their plan design.

19

Telehealth/Telemedicine & Onsite Clinics Synopsis

> Telehealth/telemedicine and/or

onsite clinics plan examples.

Telemedicine visit examples were given

with co-pays ranging from $0 to $20 per

visit.

In 2015, 11 percent of Alliance members

offered onsite clinics.

> What are the benefits?

Convenience/efficient use of resources

Lower cost for both employees and

employers

Reduced absences

ROI

> What are the challenges?

Patient experience

Plan design/location

Cost

> Experience with onsite clinics?

Employers with onsite clinics have experienced

challenges. However, once employees are educated about

how and why to use an onsite clinic, usage has increased

dramatically and for one employer has reduced urgent

care/emergency room charges due to the fact that many

employees had previously not had a designated PCP.

> Employers are split about offering

telehealth/telemedicine and/or onsite clinics.

Employers surveyed at the event encompassed a range of

thoughts on this subject from high interest to no interest.

20

How do your health care benefits compare?

Contact Member Services at mms@the-alliance.org or 800.223.4139 to request a benefits and coverage analysis report customized to your industry, geographic location or company size. A free benefit of your membership with The Alliance.

Consumer-directed Health Plans & The Excise Tax

21

Consumer-directed Health Plans & The Excise Tax Does your company currently offer a consumer-directed health plan (defined as a high-

deductible health plan with a health savings account)? If so, what do you offer? If not, why not?

> Approximately two out of three employers at the roundtable event currently offer at least

one high-deductible health plan (HDHP) with a health savings account (HSA)

> Structure of consumer-directed health plans differ by industry and by company

> Employers view consumer-directed health plans as an opportunity to …

Offer insurance at a lower premium.

Educate about health care consumerism.

Encourage employees to take an active role in their health care.

> Barriers to offering a consumer-directed health plan ….

Onsite clinic offering HSA complicates patient cost sharing

Too complicated

Difficult to kick start this

22

Consumer-directed Health Plans & The Excise Tax What role will consumer-directed health plans play in helping you minimize or eliminate your

exposure to the excise tax?

> More HDHP plan options

> Higher deductibles

> Create an educational opportunity to become a better health care consumer Consumers need to understand why it is beneficial to them to take an active role in their health care choices

Explain how much health care costs

Explain what quality data is available and how to use it effectively

Empower consumers to ask questions and make conscious choices

Have a full understanding of the parameters of the plan and changes for the new plan year

> Steer consumers toward more effective health care choices Switching from brand name to generic drugs where possible

Reduce unnecessary emergency room visits

MRI options

Use insurance cost calculators to estimate the cost before scheduling a procedure

23

Consumer-directed Health Plans & The Excise Tax What are your main concerns about offering a consumer-directed health plan?

> Employee education and creating a culture of health care consumerism

How to best educate employees?

Complexity of plan impacts adoption

Technology can be a barrier

> How to design a better health plan for the future

Embedded deductibles, flexible spending account (FSA), health reimbursement account (HRA), health spending

account (HSA), flex plan ... lots of choices.

> Uncertainties about the changing landscape of the ACA

Too many unknowns

Excise tax “not real” until it happens

> What if …?

Maximum out of pocket reached and they run the bill up?

How do we keep health care providers accountable?

Employees trust in their provider for health care information more than their employer?

> Onsite clinics work well for some companies. But are they a good fit for your workplace?

24

Consumer-directed Health Plans & The Excise Tax What other steps are you taking to prepare for the excise tax?

> Many are waiting for outcome of next election

> Ongoing employee communication

> Education

> Monitoring their report from their broker

> Incremental changes

> Excise tax analysis

> Determining the total cost since they have onsite clinics

25

Consumer-directed Health Plans & The Excise Tax Synopsis

> Approximately two out of three employers at the roundtable event currently offer at least

one high-deductible health plan (HDHP) with a health savings account (HSA).

> How will consumer-directed health plans help minimize/eliminate exposure to the excise tax?

There will be more HDHP plan options

Higher deductibles

Create an educational opportunity to become a better health care consumer

Steer consumers toward more effective health care choices

26

> Main concerns about offering a consumer-directed health plan

Employee education and creating a culture of health care consumerism

How to design a better health plan for the future

The changing landscape of the ACA

Coordination between employer, employee and providers to obtain a

better quality of care at a more cost-efficient price

Should we consider an onsite clinic?

> Employers are preparing for the excise tax in a variety of ways, but

the ACA landscape is constantly changing. We need more

information as employers and we need to educate our employees.

How do your health care benefits compare?

Contact Member Services at mms@the-alliance.org or 800.223.4139 to request a benefits and coverage analysis report customized to your industry, geographic location or company size. A free benefit of your membership with The Alliance.

Prescription Medications Including Rx & Specialty Rx Tiers

27

Prescription Medications Including Rx & Specialty Rx Tiers On a scale of 1 (lowest) to 5 (highest), how concerned are you about the impact of

prescription drug price increases on the total cost of care?

2 of 3 Approximately two of three attendees rated their concern about the impact of

prescription drug price increases as a five on a five-point scale.

1 of 3 Approximately one out of three attendees rated their concern about the impact of

prescription drug price increases as a four on a five-point scale.

28

Prescription Medications Including Rx & Specialty Rx Tiers Does your company’s prescription medication benefit currently use tiers to determine the level

of coverage for particular types of medication? If so, do you have best practices to share?

> Many

employers

reported

offering

three, four,

or more

tiers of

prescription

coverage.

> Mail order

has been an

opportunity

to lower

prescription

costs.

Providing incentives for mail order

Providing incentive adherence

Max out-of-pocket for maintenance co-pay

Initial fill only 5, then rest if patient can

continue

Low generic co-pay to drive utilization

Using Navitus – consumer driven

Collaboration (Employee, employer, drug

manufacturer)

Case management to assist with coaching

(not condition specific)

Traditional – keep to step therapy

User PBM

VB – zero co-pay

3 tier: $10 generics, 30% brand names,

30% formulary with prior approval

4 tier: $5 generics, $45 preferred brand,

> Best practices shared … Company A added specialty pharmacy to their

plan in 2015, due to the high cost of Humira

Company B uses BidRx, an online service. Enter

your prescription and pharmacies bid on filling

your prescription. Some medications are free.

This allows transparency in pharmacy costs.

Company C pays for a percentage (co-insurance

fee) instead of charging a flat co-pay.

Company D offers a 30 percent co-pay up to a

maximum of $300/month. Maximums are a real

concern for specialty Rxs.

Company E offers a 20 percent co-pay – up to

50K paid at 100 percent.

Company F splits generics into two tiers for cost,

$10 & $30 (may exclude some drugs)

Company G educates employees on max

$1,000/individual and being good stewards (e.g.

injections in doctor’s offices)

Four tiers – specialty only by mail order, incent

mail order for three- month supply

29

Prescription Medications Including Rx & Specialty Rx Tiers Have you addressed specialty medication costs? If yes, how have you done so? If not,

do you plan to do soon? What steps do you plan to take? Will tiers play a role?

> Step therapy [Noted by multiple groups.]

> Mail order only if appropriate [Noted by multiple groups.]

> Partially fill an initial specialty prescription to ensure

no negative reaction [Noted by multiple groups.]

> In own tier with different cost sharing

> Authorization

> Mandatory therapy

> White bag vs. brown bag (liability issues – concerns)

> Change to co-insurance with a cap

> Program to manage distribution, $, alternatives

> Narrow network – may or

may not work

> Condition management

> Prior authorization

> Working with pharmacy

benefit manager to review

specialty medications

> Navitus trying to secure

discounts with pharmacy

providers

> CVS – Caremark, direct

nurses assigned

30

Prescription Medications Including Rx & Specialty Rx Tiers How have employees responded to the use of tiers? Can you share any communication tips?

> Concerns shared included …

Employees think they have to go against the doctor’s orders.

Huge majority of employees use generic drugs to save costs. What more can we do?

31

Prescription Medications Including Rx & Specialty Rx Tiers Synopsis

> All of the employers surveyed rated their concern about the impact of prescription

drug price increases as either a four or a five on a five-point scale.

> Many employers reported using three, four, or more tiers for prescription prices.

> Employers are taking a variety of steps to address the steep rise in specialty

medication costs.

> Employers had more concerns than communication tips.

> Employers are looking for more information, education and guidance about benefit

plan design for prescription medications.

32

How do your health care benefits compare?

Contact Member Services at mms@the-alliance.org or 800.223.4139 to request a benefits and coverage analysis report customized to your industry, geographic location or company size. A free benefit of your membership with The Alliance.

Searching for more information on benefit plan design?

33

> Download our 2015 Alliance Summary of Benefits and Coverage Analysis at: http://www.the-alliance.org/uploadedFiles/Members/Products/2015_The_Alliance_Summary_of_Benefits_and_Coverage_Analysis.pdf

> Contact Member Services at mms@the-alliance.org or 800.223.4139 to request your

free benefits and coverage analysis report customized to your industry, geographic

location or company size. This benefit is only available to members of The Alliance.

Request yours today and see how your benefit plan compares to those of your peers.

> Visit our events page and sign-up for our next Alliance Learning Circle:

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