hCentive_BenefitsExchanges_May 08 2014
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Transcript of hCentive_BenefitsExchanges_May 08 2014
© 2014 by hCentive, Inc. All rights reserved
Our mission:
Who we are OVERVIEW
• First and Largest Developer of State Exchanges
• Integrating and Connecting the Nation’s Largest Health
Plans to all 50 Exchanges/Marketplaces
• Headquartered in Reston, VA with back office in Noida,
India. Regional Offices in NY, CO and PA
• Over 500 employees and growing
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© 2014 by hCentive, Inc. All rights reserved 4
Rajeev Mudumba Rajeev Mudumba is VP of Strategic Alliances at hCen<ve. In this role he oversees strategic partnerships & business rela<ons for hCen<ve. Prior to this, Rajeev has managed Private Exchange Solu<ons at hCen<ve. He has over 18 years of interna<onal leadership experience in the Health & Wellness and Technology Consul<ng industries. Rajeev received his MBA from Old Dominion University, Norfolk, VA. He also holds an MBA from Center for Management Research & Development, Pune, India and a Masters in Personnel Management from Pune University, India.
© 2014 by hCentive, Inc. All rights reserved
• Retail Consumerization – What is the context in the Benefits world? • What are Private Exchanges? What do they offer? What more will they
offer? • Why will Private Exchanges complement than compete with – FFM and
state-based exchanges? • How will the role of Brokers evolve in the post PPACA world?
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© 2014 by hCentive, Inc. All rights reserved
Where did we come from? An employer-driven payer model…. Where are we headed? Involve employees and individuals to make their own health decisions with a defined contribution approach…. “If at first the idea is not absurd, then there is no hope for it.”
― Albert Einstein
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Retail Consumerization – What is the Context in the Benefits World?
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© 2014 by hCentive, Inc. All rights reserved
© 2014 by hCentive, Inc. All rights reserved
• I haven’t been to my bank unless I am signing a mortgage! • Most of my travel was booked online, however; I need advise from my
agent on specifics from time to time. • I haven’t paid a bill in person or via mail
Reason – Technology has streamlined the process, minimized or removed paperwork totally and saves valuable time and energy along the way. Online Banking, Travel & Payments are here….to stay! Why not how we buy our benefits?
Over the last several years…
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© 2014 by hCentive, Inc. All rights reserved
Performance Transparency
Customer Experience
Price
Quality
What Does Consumerization Mean? A Health Plan Perspective
9Consumer Empowerment
Choice and Flexibility
More Control over
Employer Benefit $
Lower Switching
Cost
More Purchase Op>ons
Ø Industry Consolidation
v Need for Scale and Scope Economies will lead to Consolidation
Ø Business Model Innovation
v Partnered ecosystem with collective accountability will evolve
Ø Sustainability
Challenge v Unless clear Competitive
Advantage is created, member retention is difficult
Market Shifts
© 2014 by hCentive, Inc. All rights reserved
• Retail centered & consumer focused • Online and offline storefronts • Wholesale markets for individual & group plans • Point of sale innovation, integrated billing & payment services • Packaged innovative benefit plans combining traditional
insurance models with care solutions • Retail, Travel & Banking have gone through change, now it’s
health insurance & other benefits!
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© 2014 by hCentive, Inc. All rights reserved
• Create competition in the insurance marketplace
• Protect consumers
• Promote good administrative services
• Establish high standards for health plans
• Provide easy to understand information & engage consumers
• Create seamless integration with Federal & State entities
Quality Care – Efficient Services – Lower Costs
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© 2014 by hCentive, Inc. All rights reserved
• Provide consumers product/services know-how in simple terms for quick assimilation
• Provision clear, comparable information about health insurance plans
• Provide a simple, easy-to-use “shopping experience” with robust decision assistor tools to facilitate informed purchase decisions
• Facilitate ongoing support to build on consumer loyalty
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© 2014 by hCentive, Inc. All rights reserved
• Benefits has evolved into an e-commerce product, branding & appeal will play a crucial part in where the customer goes; cost & value not withstanding.
• The exchange navigators provide the orientation, education, and assistance in plan administration
• Designing your exchange to follow the consumer & the cost.
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© 2014 by hCentive, Inc. All rights reserved 15
Types of Exchange Play Exchange Operated by
• SBE at Eligible Individuals & Family
• SBE at Eligible SHOPS (<50 and <100 in 2016)
• Operated by Carriers
• Operated by emerging and established Intermediaries • New business model -‐ free benefit system to employers with broker
commission as revenue
• True compe<<ve marketplace likely operated by Benefit Expert Intermediaries
• Operated by Carriers, TPA
Individual Public Exchange
SHOP Public Exchange
Single-‐Carrier Private Exchange
Mul>-‐Carrier ’No-‐Choice’ Private Exchange
Mul>-‐Carrier ‘Choice’ Private Exchange
Single-‐Carrier Private-‐Private Exchange
What are Private Exchanges? What do they offer? What more will they offer?
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© 2014 by hCentive, Inc. All rights reserved
© 2014 by hCentive, Inc. All rights reserved
• Robust consumer-centric, functionality-oriented Web Portal • Customer Service Support • Marketing & Outreach Services • Provider Integration Support
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© 2014 by hCentive, Inc. All rights reserved 18
Move and Align Fully-‐insured Employers (or migrants from Self-‐Insured) move to Defined Contribu>on model by alloca>ng a fixed dollars
Stay and Involve Self-‐insured employers custom-‐design defined-‐benefit plans with emphasis on wellness and healthy lifestyle
Stay and Shop Fully-‐insured employers nego>ate and shop to get the best rate defined-‐benefit plans
Dump and Exit Employers pay free-‐rider penalty and exit from offering benefits to employees
Employer Benefit Strategies
Large Group Small Group
High In
come
Small Group
Low In
come
Large Group
Low Incom
e, Re>rees, High Income
High Income
Small Group
High Income
Mul>-‐Carrier ‘Choice’ Private
Exchange
Single-‐Carrie
r Priv
ate Exchan
ge Single-‐Carrier Private-‐Private
Exchange
Individu
al Pub
lic Excha
nge
Mul>-‐Ca
rrier ’No-‐Ch
oice’
Private Exchan
ge
SHOP Pu
blic Excha
nge
Small Group is < 125 Large Group is > 125
© 2014 by hCentive, Inc. All rights reserved 19
Fully Insured Employer
62.6M (20%)
Self Insured Employer
90.8M (29%)
Individual
15.6M (5%)
Medicaid
51M (16%)
Medicare
40.7M (13%)
Uninsured & Other Public (Dual etc.) 53.2M (17%)
Health Plan PE Carrier Enrollment / PE
Health Plan PE State Medicaid CMS Part A/B – 28 M Health Plan
Broker Broker Broker Medicaid Health Plan
Health Plans – Part C – 12 M Part D
Public Exchange
Benefit Consultant Exchange
TPA Public Exchange Public Exchange to Medicaid
Broker
Consor<um E-‐Broker Re<ree Exchange
PEO E-‐Broker
Public Exchange
E-‐Broker
U.S. Popula>on of about 313.9M
Consum
er Engagem
ent A
venu
es
2011-‐12 distribu<on -‐ h`p://kff.org/other/state-‐indicator/total-‐popula<on/
© 2014 by hCentive, Inc. All rights reserved
• Integration of health, payroll, workforce productivity & wellness solutions • Integration of tax-advantaged benefits (HRAs, HSAs, IRAs) • Partner with third party vendors to develop add-on insurance products
to attract employee buy in
After that…. • Follow the cost • Find triggers and send alerts to integrated products/services • Enable employee health & productivity management • Facilitate & Show Cost Savings
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Why will Private Exchanges complement than compete with – FFM and state-based
exchanges?
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© 2014 by hCentive, Inc. All rights reserved
© 2014 by hCentive, Inc. All rights reserved
• Federal Mandate: Individual and SHOP (<50 Employees)
• State Mandate: Specific to states
• Centered around Essential Health Benefits
• Compliance heavy: for payers and employers
• Large Employer: Availability in 2017
• hCentive has built the following State Exchanges: NY, CO, KY
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© 2014 by hCentive, Inc. All rights reserved
• Some compliance expected • Less rigid, offer benefits more than just health • Flexible and can be customized to address the needs of any employer
group • Richer benefits offered at competitive prices • Choice & Consumer Experience are a priority
• Are an extension to what Public Exchanges have to offer… • Can interact with Public Exchanges and bring the best of both
worlds to consumers….
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© 2014 by hCentive, Inc. All rights reserved
• Private exchanges do not replace the role of benefit consultants, agents, brokers or administrators.
• They serve as a new avenue to service clients.
• Sales through exchanges are an added revenue stream.
• Health Plans continue to move out of their comfort zones to package and integrate their products with complementary ancillary products/services to engage consumers better and keep them.
• Innovation in exchange marketplaces in terms of new offerings as well as new ways to package and sell products ensures the health of a growing new market.
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© 2014 by hCentive, Inc. All rights reserved
• Private Exchanges drive an advantage by integrating tightly with federal & state exchanges to ensure consumers have the advantage of reviewing their federal subsidy eligibility on the public exchange and make purchases within the private exchange.
• Public Exchanges are able to extend their presence into new
marketplaces while private exchanges are able to provide the best of both worlds to consumers.
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© 2014 by hCentive, Inc. All rights reserved
• Private Exchanges enable Brokers, Employers and Members to interact in more meaningful and beneficial ways with the end consumers.
• Private Exchanges offer robust financial modeling & decision making tools to support the online shopping experience.
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How will the role of Brokers evolve in the post PPACA world?
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© 2013 by hCentive, Inc. All rights reserved
© 2014 by hCentive, Inc. All rights reserved
§ Be open to adapt, move from being a sales agent to a consultant, an educator § Tap into Individual Markets through Small Businesses not offering health insurance, as
you know insurance is mandatory. § Become a cer<fied producer with your State Exchange. § Partner with a defined contribu<on provider to provide plans to small businesses that
cannot afford or meet minimum par<cipa<on requirements to offer group plans. § Incorporate a Private Exchange solu<on! Offer products beyond health. § Become an Obamacare expert.
Ninety-‐four percent of small businesses believe the need for an outside advisor will increase or stay the same in the next two years. According to the U.S. Census Bureau, 98 percent of businesses in the U.S. have fewer than 100 employees, accoun>ng for approximately 35 percent of the U.S. workforce (40 million workers). Yet only half of these companies use an advisor for business or personal needs regardless of whether they offer benefits to employees.
-‐ LIMRA, Worldwide Research & Consul<ng Org.
© 2014 hCentive, Inc. All Rights Reserved. 28
© 2014 by hCentive, Inc. All rights reserved
WebInsure Benefits Exchange
Employees
Shopping Enrollment Administration
Integrated Shopping
HRA/HIA
Consolidated Enrollment SSO/API Integration with Administrators
Medical Dental Vision Life Accident STD/LTD
Carrier Dispatching
Life Status Changes
COBRA
COBRA
Commuter Transit 401 K FSA
Integrated Experience
Payroll Integration Renewals
Payroll
Consolidated Billing
An integrated benefits management suite that assists employers in the design, purchase and administration of employee benefits or contribution while bringing the cost advantages
of a competitive marketplace and lowering the administrative costs.
Exchange Operations
G R A P H I C R E P R E S E N T A T I O N
WebInsure Benefits Exchange
Employer
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© 2014 by hCentive, Inc. All rights reserved © 2012 hCentive, Inc. All Rights Reserved.
§ Lower total cost of client ownership through outsourcing § Complete payroll reconcilia<on process § State-‐of-‐the-‐art support center with consistent, consistent messaging to par<cipants
§ Customized communica<ons and fulfillment services; variety of methods to provide consistent, focused message
§ One-‐stop-‐shop for client benefits administra<ve needs § Breadth of product line made available § Parameter-‐driven, flexible configura<on -‐ permihng complex case set up § Automated electronic verifica<on and reconcilia<on of eligibility feeds
© 2013 hCentive, Inc. All Rights Reserved. 30
© 2014 by hCentive, Inc. All rights reserved
Contact: Rajeev Mudumba | VP Strategic Alliances Direct 732.309.2228 [email protected]
Questions?
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