PPACA, Exchanges, and Benefits Enrollment Challenges

September 11, 2012

The Patient Protection and Affordable Care Act is an increasingly popular topic. Many people refer to the new healthcare plan as “Obama-care” or PPACA. So what’s all the fuss about?

The PPACA was implemented in order to allow more Americans access to healthcare with the goal of decreasing costs and patient satisfaction. Sounds simple enough, right?

Private and Public Exchanges Defined

Unfortunately, it’s not. There are a variety of options that can fall under a Private Exchange or a Public Exchange, causing decision-making and confusion more prevalent.

“Government-funded” public exchanges cannot be all things to all people, nor are they intended to be. Individuals and small employers who are eligible for and accept available subsidies should shop through a public exchange. Five product options will be available through the public exchanges to those individuals accepting subsidies. This provides an easy-to-use and efficient product mix for this defined client base. Private exchanges must remain the focus for carriers and payors that are not eligible for government subsidies and have worked for decades to provide accessible and affordable care to both individuals and small employers.”

Health exchanges, either private or public, provide consumers, individuals and families, a way to compare and buy health insurance. In general, exchanges are designed to:

  • Create a competitive marketplace.
  • Inform consumers and improve cost transparency.
  • Offer affordable health insurance and wellness choices.
  • Ensure transactional ease and efficiencies via eHealth technology improvements.

Both private and public exchanges carry unique strengths and varying structures that appeal to individuals and employers alike. According to Booz & Company research, public exchanges give plan access to subsidized populations and small businesses while private exchanges offer extensive design packages and benefit choices. Regardless of exchange type, they found employers and consumers desire “guided” support, product recommendations, and real-time administrative support via chat or phone.

Employer Benefits Enrollment Challenges

According to a Gantry Group Inc. Report: “HR/benefits executives plan to allocate 46% of their information technology budget to talent and performance management, recruitment, leadership initiatives and compensation management.” There have been reports, surveys, and projected statistics regarding operating costs of the enrollment process and healthcare plans as well as the lack of engagement and complication in enrollment. Some are as follows:

  • Dissatisfaction with HR solutions arises primarily from vendors’ poor response to problems (46%), poor integration with the company’s infrastructure (41%), poor performance (38%) and an increase in HR process complexity (36%).
  • Large and midsize employers will spend, in the next 12 months, an average of $1.14 million on workforce management solutions and services, reports the Gantry Group, LLC.
  • According to Towers Watson, changing employees’ health behaviors has been a major obstacle for many companies. Above all, the lack of employee engagement is cited by 57% as the biggest obstacle to managing employee health.

These statistics reiterate some of the main challenges associated with plan enrollment. With the increasing number of people enrolling in plans, due to the new PPACA, companies need to be proactive and offer efficient open enrollment processes and engaging wellness programs.

Workplace benefits packages cover a wide range of things such as: health and dental insurance, short and long-term disability, legal aid, life insurance, etc. Numerous plan choices can cause confusion and create higher demand on plan reps and benefits managers during enrollment, thus driving costs up and losing voluntary benefits participation.

So with a variety of plans and an overwhelming amount of paper-driven processes, employers are seeking alternatives to increase participation and engagement.

Intelligent Virtual Assistants Increase Engagement and Clear Up Benefits Confusion

Watch Hanna explain why critical illness coverage is important to this employee based on their choice of a high deductible health plan.

Intelligent virtual assistants are one way employers and carriers are looking to close the gap. They provide an online, emotional connection that can complement or replace the benefits enrollment meeting / process. The employee may choose which parts to review or be directed to listen to each segment as the employer sees fit, and at any time, seek live help through email, phone, or live chat integration.

For example, they assist employers when selecting benefits offered to their employees on the exchange or employees when making decisions based on a defined contribution plan.  Additionally, it drives users to complete forms such as banking information and HSA applications. And because of real-time support, health exchange providers and payors experience a decrease in calls and a reliance on chat and email creating additional efficiencies and a more satisfying benefits shopping experience.   

“HR administration costs projected to grow by 7%“ http://ebn.benefitnews.com/news/hr-administration-costs-projected-grow-7-578281-1.html 

“The Emergence of Private Health Insurance Exchanges Fueling the “Consumerization” of Employer-Sponsored Health Insurance” 2012 http://www.booz.com/media/uploads/BoozCo-Emergence-Private-Health-Insurance-Exchanges.pdf

Issue Brief: “Why Public & Private Health Exchanges Must Co-Exist” www.BenefitMall.com

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