January 25, 2014
I joined a panel of experts on exchanges, health care reform and insurance to give insights on ACA plans going into effect. To The Point tweeted key comments from each of us, including:
- Bryce Williams, Towers Watson, @brycewatch:
The ACA could be major boost to entrepreneurship
- Sarah Kliff, Washington Post, @sarahkliff:
36 hrs into Obamacare, vast majority can signon & signup w/in an hr
- Susan Shargel, Shargel and Company
- David Nather. Politico, @DavidNather
- Gerald Kominski: UCLA Center for Health Policy Research, @UCLAFSPH
In the full podcast, you’ll hear comments on these points and more:
The New Year brought with it medical coverage for millions of Americans under the Affordable Care Act. On Jan 1, about two million people began to receive private health coverage through the state health exchanges or the federal website.
With one of the nation’s most sweeping changes to social policy in decades, no longer can insurers deny coverage to people with pre-existing conditions, or charge them more for their coverage than other customers. It’s also the first time they can’t legally charge women higher premiums for the same coverage as men, and the first time they can’t set a specific limit on the amount they spend on “essential health benefits” for individual policyholders.
But there are a lot of “if’s” in the implementation of Obamacare:
- Will people be able to find a doctor who accepts their new plan?
- Are the nation’s healthcare providers ready for the change in policy?
- How will Obamacare shape the political climate this election year?
November 30, 2013
I’m proud to share some recognition in the fields of health care business and consumerism.
Modern Healthcare: 2013 Healthcare’s Hottest Companies
The Exchange Solutions segment of Towers Watson, launched with the acquisition of Extend Health, was recognized by Modern Healthcare for being one of the fastest growing health care companies in the U.S. – named 4th among a great group of companies.
Institute for HealthCare Consumerism: 2013 Innovator > See pg 63
I’m honored to be named among some very esteemed industry figures by the Institute for HealthCare Consumerism. See page 63 to learn a little about the early days of Extend Health and what’s it’s meant to my team at work and at home to be in the leading wave of health insurance exchanges in our nation.
November 23, 2013
I spoke with several journals about what the Liazon acquisition means for Towers Watson and the exchange space. This coverage pulls in opinions from across the industry as well as my highlights.
Private Health-Exchange Market Consolidates, David McCann
My highlight: “Towers Watson has plenty of good reasons for buying Liazon….The market is moving so rapidly, and there’s a sense that a tipping point is being achieved…It’s as if the music just stopped and we grabbed the last chair.”
Towers Watson expands private exchanges with $215M Liazon purchase, Jerry Geisel
My highlight: “Liazon has “the most sophisticated insurance platform by a mile in this market.”
Towers Watson’s private exchange division leader details advantages of Liazon purchase, Kathleen Koster
My highlight: “We want to be the leading player in private exchanges….A year and a half ago, they [Towers Watson] bought the leading retiree exchange in Extend Health. Today, they’re buying the leading active exchange technology company, Liazon….The acquisition gives Towers Watson the ability to hit the market very quickly with all the most sophisticated exchange technology out there.”
More on the acquisition
- Towers Watson’s announcement
- Wall Street Journal
- Huffington Post Business
- Bloomberg BusinessWeek
- Daily Finance, Motley Fool
- Insurance Networking News
- Employee Benefit Advisor
- Plan Sponsor
A closer look at Liazon
- New York Times, The Landscape of Small-Business Health Insurance
- FastCompany, This Buffalo Startup Built the Amazon of Health Care Buying
Towers Watson Acquires Liazon to Expand Private Benefit Exchange Offerings Through Multiple Channels
November 22, 2013
Transaction complements Towers Watson’s OneExchange with scalable, flexible solution
NEW YORK, November 22, 2013 — Towers Watson (NYSE, NASDAQ: TW), a global professional services company, announced today that it has acquired Liazon Corporation, a leader in developing and delivering private benefit exchanges for active employees. The acquisition, which follows the purchase of Extend Health in June 2012, solidifies Towers Watson’s strength in the private exchange market through its OneExchange solution. Going forward, Towers Watson will continue to enhance Liazon’s award-winning private exchange solution and serve the needs of Liazon’s leading broker, consultant and carrier partners, some of which offer the Liazon product under their own brands.
December 15, 2012
On December 6th, New Jersey Governor Chris Christie vetoed a bill that would have created a health insurance exchange for his state under President Barack Obama’s signature healthcare reform law. Leading up to the states’ December 14 deadline to declare whether they would run their own exchange, many have interpreted state decisions to operate their own exchanges – or not to – along political lines.
I talk about state exchanges with Dan Gorenstien in his Marketplace piece, “States must make health care decisions,” and with Alex Wayne in his Bloomberg.com article, “Insurers Face Jumbled Market With Health Exchange Rules.” But the decisions we are seeing now are much less political, than practical. Here’s why.
First, health insurance exchanges are the law of the land based on last summer’s Supreme Court decision on the constitutionality of the Patient Protection and Affordable Care Act (PPACA or ACA) and cemented by President Obama’s re-election. There will be no repeal of Obamacare. That political window has now closed.
Second, under ACA, a state can choose to have the federal government run its health insurance exchange either on an interim basis or indefinitely. So residents of New Jersey, Tennessee and other states that are leaving it to the Feds will have access to individual health plans on January 1, 2014 through a health insurance exchange. They will be covered.
Here’s why the move is practical. I know from running the nation’s largest private Medicare exchange for the last eight years that building an effective exchange does not happen overnight. It is time consuming and costly, with many moving parts.
There is the underlying technology and the crucial relationships with the health insurers that will offer plans in the exchange. There is the initial consumer outreach, education and support while consumers are evaluating and choosing plans and enrolling. There are the complex eligibility requirements that some individuals must meet to receive federal subsidies. Lastly, there is the reality that the newly insured will move between company, Medicaid and individual coverage at frequencies never before seen or managed.
Not knowing the details of what it will take to build and run an exchange or how much it will cost, Christie, Haslam and others feel it’s best to let the federal government run it for now. And they can revisit the decision in the future.
This makes practical sense. The states that will run their own exchanges from day one have been working on them for more than a year. For example, California was the first state to declare that it would run its own and appears to be further along than any other.
For New Jersey and others, at this time, it is the right move. That could change next year as more information about the success of the first state exchanges becomes known to the governor and state legislative leaders.
Governor Christie is right: This is a practical – not political – move.
- States must make health care decisions, Marketplace
- Insurers Face Jumbled Market With Health Exchange Rules, Bloomberg
- Map: Is Your State Building A Health Exchange?, Kaiser Health News and PBS Newshour
June 20, 2012
Knowledge is power — the power to think, to act, to buy, or even to not do any of the above. Our nation’s health insurers and health care providers need to figure out how to put power back into the hands of consumers. Consumers today have too many constraints when it comes to accessing decision-critical information about the cost of health care. That’s a hard pill to swallow when there’s so much at stake.
A recent post on The Health Care Blog featured a fascinating yet not unsurprising finding: The cost for appendectomies can vary by more than $100,000 between health plans and hospitals.
Dr. Renee Hsia of UCSF was asked what appendectomies cost by a friend who had to pony up over $50,000 in co-pays for one. Dr. Hsia’s research, which looked at pricing variability across the state of California and was published in the Archives of Internal Medicine, found that an appendectomy could run from $1,529 to $182,955 — varying as much as $7,504 to $171,696 within one hospital.
The question of where to begin is starting to be answered by sites like FAIR Health’s Consumer Cost Lookup. It uses continually updated claims data from insurers and third-party administrators for 126 million people to benchmark costs. Visitors to the site can find typical rates for certain services in their area as well as what Medicare pays.
Fourteen other states have or are setting up searchable databases to help compare health care prices and quality.
The savings that can be realized are impactful not only for consumers but for health insurers themselves. Because half its members had no idea when they were being referred to out-of-network providers, Aetna launched a service to let members know if their outpatient surgery could be done by an in-network provider. In many cases, the surgery could be done less expensively, in-network reducing out-of-pocket costs for Aetna members, not to mention for Aetna.
More and more insurers are trying to help people locate services and compare costs, like UnitedHealthcare’s postcard campaign, which lists costs for common lab services at in-network and out-of-network facilities in members’ local areas and its online tool for estimating the costs of over 100 common treatments.So what’s central to all of these stories? Information.
In the California appendectomy story the information was too hard to get: too many sources, too many different plans. And, technically Aetna didn’t offer consumers (and network doctors) anything they didn’t already have access to. The information was just too hard to piece together and act on.
What these stories show us is that health care consumers today need access to information, plus tools and services to make sense of it all. Like Aetna, United Healthcare and other insurers who have developed cost-comparison tools for consumers, the insurance side of health care has been making cost information more available to aid consumer decision-making. We look to healthcare providers and hospitals to start doing the same.
Bringing transparency to the costs of services and products can supercharge consumer decision-making, forcing healthcare providers and hospitals to be more upfront with price information and to work on getting a better handle on costs for “incidents of care.”
The Extend Health exchange platform is a great example of transparency in an insurance shopping site. It delivers information on thousands of private Medicare plans to our customers — and it does it in an easy-to-understand way. Our system supports benefit and cost transparencyby allowing customers to compare plans side-by-side and estimate their prescription drug costs for the year. These tools, along with the opportunity to speak with a benefit adviser if they wish to, help ensure that our customers find the plan or plans that meet their health needs and the needs of their budget.
Massachusetts and Utah already offer the ability to buy health insurance online through their state exchanges. The upcoming Supreme Court decision on the Patient Protection and Affordable Care Act will determine if citizens in every state will have the same opportunity. If all or part of the ACA is struck down, health insurance exchanges — a forum whose effectiveness is based on transparency in costs, benefits, services and products (such as drugs) — could be in jeopardy.
- A 14-month effort to answer one question: Can shopping for insurance be easy?
- Paper Cuts: Reducing Health Care Administrative Costs
- HHS site tracks government data on health system indicators, such as access to care and costs
- Attributes of a Health Literate Organization
- Data trove may shed light on health-care uncertainties
December 16, 2011
It’s been an insane month – lots of travel, and I haven’t had a chance to post anything lately. The Extend Health blog just posted a great roundup of news and opinion on the Ryan-Wyden plan, which is worth a read – reprinted here in its entirety for your convenience.
Paul Ryan (R-WI) and Ron Wyden (D-OR) released their proposal to overhaul Medicare this week. It is not at the bill stage yet, as the authors hope to cut down on the political rhetoric and start a serious national dialogue about the future of Medicare. Ryan and Wyden have not asked the Congressional Budget Office to review their proposal yet, so it is not known how much their plan would save compared to current Medicare.
Here is a brief overview of some of the plan’s key points:
People over 55 would see no change to their benefits. They would be free to opt into a private plan when the Medicare Exchange is established in 2022.
The “premium support” system would ensure affordable coverage by empowering seniors to choose either traditional Medicare or private plans. And there would be more help for low-income seniors who need it, and less for wealthier seniors who don’t need the assistance.
Medicare plans could be purchased on an insurance exchange established by congress.
Strong consumer protection would include:
- All participating plans would have to offer benefits that are at least equal to traditional Medicare plans.
- Risk-adjusted premium-support payments would guarantee affordable coverage for those with the greatest health needs.
- Plans could neither refuse coverage for pre-existing conditions, nor charge rates that discriminate based on health status.
- CMS would oversee all plans to ensure transparency and fairness.
Competition would drive program growth. Competitive bidding would force providers to reduce costs and improve quality. Competition between private and traditional Medicare plans would incentivize both to develop better delivery models and ways to care for patients.
Employees in small businesses with up to 100 workers could use their employer’s contributions to purchase their own health insurance, and the cost of free choice options would be fully tax deductible to the employer. In addition, allowing workers to keep the same insurance when they retire would ease their transition into Medicare.
Medicare spending would be capped to GDP plus one percentage point.
Read the full report: http://budget.house.gov/UploadedFiles/WydenRyan.pdf
Here’s a roundup of news articles written this week about the Ryan/ Wyden proposal, with reactions and opinions from across the political spectrum.
Bloomberg BusinessWeek: Bipartisan Medicare Plan May Spur More Compromise, Ryan Says
The Washington Post: Interview with Rep. Paul Ryan
Boston.com: Clipboard: The “Ryden” Medicare proposal
Chicago Tribune: White House blasts new Medicare plan by GOP’s Ryan
The Wall Street Journal: A.M. Vitals: Ryan, Wyden to Introduce Proposal for Changing Medicare
The Washington Post: What Wyden-Ryan hath wrought
The Wall Street Journal: The Wyden-Ryan Breakthrough
Kaiser Health News: Wyden And Ryan Join Forces On New Medicare Overhaul Plan
The New York Times: Lawmakers Offer Bipartisan Plan to Overhaul Medicare
Visit Extend Health — the nation’s largest private Medicare exchange.
October 3, 2011
My latest Fast Company blog post here. A new Kaiser study shows that health care premiums are skyrocketing, but as new provisions of health care reform come into effect, companies can do a lot to make their employees healthier for less money.
- How Employers Plan to Deal With Health Care Reform (extendhealth.wordpress.com)
- Cost of Health Care Premiums Spike in 2011 (extendhealth.wordpress.com)
- Study: Employers’ Health Care Costs Up 9 Percent (npr.org)
- Health insurance costs soar, study says: Will trend last? (cbsnews.com)
Visit Extend Health — the nation’s largest private Medicare exchange.
September 22, 2011
Yesterday I spoke with Emily Chasen, writer for the Wall Street Journal CFO journal, and today she published this piece about the future of private exchanges as a mechanism for providing health care benefits to active employees. You must be a subscriber to see the whole story, but here’s a snip:
“…a corporate exchange could be a middle ground between keeping a group plan and leaving employees to use the state exchanges. Regulations that would affect corporate exchanges are still being written, so most companies will probably want to wait for the new laws to take effect in 2014 before deciding whether to use them….According to Bryce Williams, CEO of health-care exchange operator Extend Health, such corporate exchanges could offer companies an alternative to buying group plans from a health insurer.”
Visit Extend Health — the nation’s largest private Medicare exchange.
September 19, 2011
Earlier this year, I wrote an article for InsuranceNewsNet offering my opinion that the individual mandate provision of the Patient Protection and Affordable Care Act (PPACA) is not essential to achieving the law’s goal of ensuring that tens of millions more Americans have health care coverage. The individual mandate provision requires all citizens to obtain health insurance by 2014 or pay a fine.
In the past 30 days, court rulings on both sides of the question of whether the individual mandate provision is constitutional makes it even more likely that the U.S. Supreme Court will review the matter sooner rather than later.
The unconstitutionally of the individual mandate has become the central argument of opponents in legal challenges to the entire law. They argue that if such a key provision is ruled unconstitutional, the entire law should be unconstitutional. It also remains unpopular with average Americans. In a new poll out last week from the Associated Press and National Constitution Center, 82% of respondents said “no” when asked, “Do you think the Federal Government should have the power to require all Americans to buy health insurance, and to pay a fine if they don’t?”
We’ll have to wait and see how the U.S. Supreme Court rules to know the fate of the provision. But my own opinion hasn’t changed. Based on our experience at Extend Health, if a health insurer offers seniors a private Medicare plan that meets their needs at a price they can afford, they will buy. This is because certain conditions for Medicare-eligible seniors exist that do not exist for all Americans. Most important, Medicare is guaranteed issue and requires standard plan designs.
Guaranteed issue means seniors cannot be denied coverage because of their health status. Standard plan design makes it possible to compare and contrast different plans from different carriers more easily. And these are exactly the conditions all uninsured Americans will experience under PPACA starting in 2014.
While I still believe that these conditions are necessary for large numbers of uninsured Americans to buy health plans without a mandate, today I would also argue they are not sufficient. In addition, the key stakeholders driving the extension of health care coverage to more Americans will need effective outreach programs to ensure that all Americans know their options, understand their eligibility for the federal subsidies that will be offered, and know where and how to purchase health plans.
A large group of these stakeholders – health insurers, health care providers, associations and health care nonprofits – took a major step in the right direction last week when they launched a nonprofit coalition with the mission of ensuring that “all Americans are enrolled in and retain health coverage.” Enroll America will do this by working to ensure that enrollment processes are simple and streamlined and that people know where they can go to find the right information at the right time.
It’s too early to tell whether Enroll America will be successful. But the importance of its mission cannot be underestimated. While the ACA lays the foundation for insuring tens of millions more Americans with guaranteed issue and standard plan design, finishing the job will require that every American understand what’s coming, and what they can do and when.
Visit Extend Health — the nation’s largest private Medicare exchange.