25 WAYS FOR BROKERS TO AVOID BECOMING OBSOLETE UNDER PPACA/OBAMACARE?

The question could be asked, "Was PPACA/Obamacare intended to create planned obsolescence for Brokers?"  If so, how can Brokers beat the system?

The past is gone forever - When it comes to Brokers working with Employers on Employee benefits plan design, PPACA/Obamacare has changed the game!  A the major component, Health Insurance has an entirely new set of rules and choices. Brokers who are not changing will become obsolete!

Its time for Brokers to quit pondering the future of reform and worrying about lost commissions and renewals. They need to begin offering Employers and Employees Strategies and Solutions for dealing with Reform! The Brokers business and financial future depends on creating new paradigms.

2014 is on the way! - With only 4 months to go until the traditional enrollment periods begin in October for a January 1st effective date, many Employers - and Brokers - have no idea what to do. Reading, or listening to, the barrage of media is enough to scare an owner to death. Just look at these Headlines:

• ChiefExecutive.net - "Can CEOs Find Relief From Skyrocketing Health Costs?"
• The Wall Street Journal "ObamaCare's Health-Insurance Sticker Shock"
• The Washington Free Beacon - "Obamacare to Increase Premiums Nearly 100 Percent"

The good old days - In the past Employers were accustomed to a Broker stopping-by, gathering information, discussing price increases, and offering ideas about cost-sharing, higher deductible, and other bandage solutions. This year PPACA - and the mountain of HHS, DOL, and IRS guidelines - combined with the real threat of Taxes, Penalties, and Fees - presents a new, ongoing set of problems that have Employers searching for compliant Strategies and Solutions. To survive Brokers need to be at the Employer's side to assist in this time of confusion and need!

New competition - To take advantage of this disruption, competing Brokers - as well as PEOs, TPAs, Payroll Companies, Enrollment Companies, and Technology Companies, etc. -  are knocking on Employer's doors - actual or virtual - to steal business by offering options for dealing with PPACA/Obamacare. They are differentiating themselves in the Marketplaces with new Starategies and Solutions. As Nelson Griswold pointed out in the Employee Benefit Advisor, the competitors "Turn PPACA compliance into profit". In addition, the traditional service providers - who were in the Brokers' ally in the past - are becoming commission based competitors. They are offering Voluntary and Ancillary plans for the lucrative commissions. Unlike Brokers who are still worrying about their lost Health Insurance commissions and renewals, the Service Providers are discounting their services to gain the Voluntary /Worksite Commissions. What's a Broker to do?

Get Moving - Schedule a meeting with current and potential Clients and offer them Strategies and Solutions. Here are 25 ways to get started:

1. Answer questions and address concerns they have about PPACA/Obamacare.
2. Make sure their current plan documents are compliant. Help them avoid hefty Penalties, Taxes, and Fees.
3. Run through a timeline for Reform Implementation. 
4. Help calculate the Full Time (FT) and Full time Equivalent Employees (FTEs).
5. Explain how Reform differentiates between Small and Large Employers.
6. Determine if they qualify for Tax Credits as a small business? - Help them with the paperwork?
7. Determine if their Employees qualify for Subsidies?
8. Explain the Play or Pay options. Help determine what is best for them and their Employees.
9. Review the Penalties, Taxes, and Fees.
10. If they have a Union Negotiated Contract, help determine when they need to make changes to be compliant?
11. Explain Self-Funding as an alternative to a Fully Insured Plan? If appropriate, assist in selecting a TPA. Help select stop-loss coverage.
12. Explain Qualified Health Plans (QHP) and the Essential Health Benefits (EHBs). Most Employer's major concern this year will be the Health Plan, Compliance, and Cost!
13. Explain Exchanges (Marketplaces): Federal, State and Private.
14. Review the "Metallic Plans" - Bronze, Silver, Platinum, and Gold. Explain the "Actuarial Values".
15. Determine if introducing HRAs and/or HSAs combined with a High Deductible Health Plan (HDHP) is appropriate.
16. Assist in selecting a Carrier(s) for the Health Insurance Plan(s).
17. Suggest a "Menu" of Voluntary/Worksite and Ancillary Benefits utilizing the best-of-class of Carrier/Providers as well as Plans, Programs, and Services to meet the Needs and Price-Points of the Employees. 
18. Suggest pre-taxing Employee contributions for qualified Plans under Section 125 and tax-advantaged Reimbursement Accounts. Assist them with the Model Plan Documents and in selecting the TPA?
19. Work with them in dealing with Part-Time and Seasonal Employee's.
20. Determine what Plans could be offered to the Part-Time and Seasonal Employees.
21. Discuss Defined Contribution (DC) as an alternative Benefit Plan Design to assist them in Budgeting Benefit Costs and in offering a Menu of Employee Benefit Choices.
22. Offer a Private Exchange Platform - utilizing emerging technologies - for offering the Benefit Plan Choices
23. Help design and implement the Education, Communication, Enrollment an Data Management Processes. Help co-ordinate the Enrollment.
24. If appropriate, discuss the Insurer's Medical Loss Ratios (MLRs) and the impact on your  revenues - as well as your capacity to provide required services. Start discussing a shift to a partially "Fee Basis" Model!
25. Let them know you will be at their side to assist as new Guidelines and Regulations roll-out to keep them compliant and avoid Penalties, Taxes, and Fees - Become Their Trusted Advisor!

What's next for the Broker? The above is obviously a major shift from old norms! The disruptive changes generated by Healthcare Reform demand new Strategies and Solutions! To survive in this new environment, Brokers must gain an understanding about the intricacies of PPACA/Obamacare and the plethora of Guidelines and Regulations. In addition, Brokers need to revamp their established business plan to cope with the lost commissions from Health Insurance Plans and new demands for Services.

For several months we, BenefitPlace.biz, have been suggesting "Five Strategies for Survival" that we will assist in implementing!  Quite simply these are:

1) Utilize Inbound Marketing to Shorten Selling Cycles, Reduce Marketing Costs, and Increase Revenues.  Our Listings on BenefitPlace.biz and becoming an Exhibitor on BPTradeShow.com are a fast start toward success.

2) Integrate Technology Solutions to create efficiency and cost-saving. 

3) Integrate Employee Benefits and Plan Choices to meet the needs and price-points of the Employers and Employees.

4) Utilize Defined Contribution (DC) Plan Design to help the Employers budget Costs and provide Employee Choices. 

5) Offer Employers access to a Private Exchange to provide efficiency and for you to remain competitive. 

Keeping Brokers Ahead of the PPACA/Obamacare Learning Curve, we have developed a series of 6 one hour Coaching Sessions on PPACA/Obamacare. The affordable Recorded Sessions - including Power Point Presentations -  will be available this week at $29.99 per Session or $129 for the entire package. You will have 24/7 access! The Session Sessions are titled:

A) An Overview of PPACA and other Health Insurance Reform - From the Employers Perspective - A Focus on their Myths, Questions, and Concerns 

B) Decisions and Calculations Required For Remaining Compliant and Alternative Strategies - Dealing with the Play or Pay Choices and other Related Decisions 

C) Status of Health Insurance and other Plan Choices Under PPACA/Obamacare - A close look at the ailable Plan Options - Core, Voluntary/Worksite and Ancillary - as well as Tax-Advantaged Reimbursement Accounts

D) Employer and Employee Focused Plan Design Strategies - Meeting Employer's and Employee's needs within their Price-Points while dealing with PPACA/Obamacare Guidelines and Regulations

E) A Focus on Small Business Owners and Dealing with PPACA/Obamacare - The Small Business Owners face an entirely different set of Guidelines and Regulations - as well as Plan Choices under PPACA/Obamacare.

F) Broker Survival in 2013 and Beyond - A Focus on Viable Strategies and Solutions for Brokers in Re-Tooling their Operations and Working with Employers in 2013 and Beyond

For more information about these Sessions -- Email - max@benefitplace.biz - or Call 216.577.1307.  Watch for announcements and how to order the Recorded Sessions on our Linkedin site - http://www.linkedin.com/in/benefitplace

THE NEW EFFICIENT AND COST-EFFECTIVE "GATEKEEPER" MODEL FOR CONTAINING HEALTHCARE COSTS

With Health Insurance and Healthcare costs continuing to skyrocket and access to trained Doctors decreasing, something needs to change.  The current system is expensive, wasteful, and inefficient.  We are proposing a new Gatekeeper Model that will provide Employees greater access to Doctors at a fraction of the cost with far better outcomes.

The Traditional Gatekeeper Model for Healthcare?
What was the traditional Healthcare Gatekeeper Model?  The Alliance for Health Reform guidebook defines the gatekeeper/care manager as a “Health Care professional, usually a primary care physician, who coordinates, manages, and authorizes all health services provided to a person covered by certain types of health plans. Unless an emergency exists, the gatekeeper generally must pre-authorize referrals to specialists, hospitalizations and lab and radiology tests.”  

Unfortunately this system was often plagued by redundancies  inefficiencies, and added - not reduced - costs.  It has become more and more difficult to gain a Doctor appointment and the emergency rooms are overrun.  Under this system - and the other traditional norms for bringing those in actual need of care together with physicians - there is a tremendous waste of time and money!

A few vital statistics! 

70% of Doctor's Office Visits are Unnecessary

55% of ER Visits are Unnecessary

41% of ER visits are unnecessary because the Patient could not Get a Doctor's Appointment

51% of Ambulance utilizations are unnecessary

The existing norms obviously have problems.  The difficulties in gaining an appointment with a Doctor are growing.  PPACA/Obamacare will make this a bigger problem.  Millions of people will have new found access to health insurance and will expect access to Doctors.  The old system was already dysfunctional and now will be more stained. 

The new Gatekeeper Model!
Utilizing Telemedicine as the Gatekeeper to bring people quickly and efficiently together with Doctors.  This will remove the Barriers between Employees and Doctors for determining the best course of medical action.  Telemedicine is not new!  There are a number of Vendor/Providers.  Each provides a different level of service and different cost structure.  Most would not qualify as a Gatekeeper!  I'll qualify the requirements below.

The Telemedicine/Gatekeeper Model is new!  When the Employee or Family Member Calls the Doctor First - utilizing the Telemedicine Plan - they immediately access an emergency trained doctor who assists them with their medical need, coordinates, manages, and authorizes all health services required as part of their Employer's Health Plan. The Gatekeeper Doctor authorizes the referral to a specialist, hospital, urgent care facility or lab for tests if needed.  

Let's look at how Telemedicine could be utilized as the Gatekeeper.
What must the Telemedicine Plan Provider/Gatekeeper be capable of providing based on the Plan Providers history and their Telemedicine Plan Design?

• A case specific ROI Calculator to show the Employer, CFO, TPA, etc. the value of implementing and supporting the model.
• Immediate access to emergency room trained US doctors - no messaging or call backs.
• Accepts emergency and non-emergency calls
• The ability to direct the caller to Emergency Rooms or Specialists care if medically required.
• The ability to prescribe needed pharmaceuticals as required based on a health history when the person joined the plan.
• A doctor's prescription medical kit - in the possession of the member - providing the proper tools to administer what the doctor directs over the phone while the member is heading to their doctor's office, urgent care center, or resting where they are.
• Follow-up with the member after diagnosis and treatment to ascertain if there are additional needs. 
• A focus on lowering health Plan utilization costs while encouraging the use of the Telemedicine System and their trained Doctors.
• A flat, affordable monthly fee for the Telemedicine Plan that includes the cost of the doctor's medical kit.
• The Telemedicine Plan must be affordable and yet have a depth of services required to encourage Employees to Call the Gatekeeper Doctor First reducing unnecessary utilization of the core healthcare plan.
• No extra fees or charges for usage by the participants or their family members.
• The Telemedicine Plan must be: (1) a qualified health deduction for the Employer, (2) qualified under Section 125 for the Employees to pre-tax a contribution to the Plan, and (3) HRA/HSA qualified.
• The Telemedicine Plan must provide assistance to the Broker and Employer for implementing the Plan and Educating the Employees about Calling the Doctor First and utilizing the Plan as the Gatekeeper.

The above merely describes what features the Telemedicine Gatekeeper must provide the Employer and Employees to reduce costs while increasing Doctor access.

Now let's look at what the Employer, Broker, and Telemedicine Provider (and possibly the TPA) need to accomplish when establishing the Telemedicine Plan as a Gatekeeper:

1. Determine the Employer's specific ROI for implementing the Telemedicine/Gatekeeper Plan.
2. Determine who will pay for the cost for the Telemedicine Plan - optimal ROI will be achieved if the Employer pays for the plan and all Employees and their Families are on the Plan.   
3. Create an Employee Benefit Plan Design that requires the Employees and their Family Members to Call the Doctor First (unless there is an absolute emergency) to begin the process of diagnosis and how to proceed with medical care. 
4. Include in the Employee Benefit Plan Design an added cost for Doctor visits if the Employee or Family Member does not Call the Doctor First - much like going out-of-network charges.  This will help Encourage Plan and Gatekeeper Utilization, Provide Better Employee Care, and Increase ROI.
5. Create a systematic program - including Owners, Executives, the CFO, etc. - for Educating Managers and Employees about the Plan, Timelines for Implementation, Effective Dates for Coverage, and Proper Utilization of the Telemedicine/Gatekeeper Plan. 
6. The Owners, Managers, and CFO must be involved in monitoring the Gatekeeper Plan to encourage Plan Utilization by Employees and in reducing unnecessary Core Benefit Plan Utilization.    

Five steps to implementing a Telemedicine/Gatekeeper Plan!

• Work through an ROI Calculator to establish the Potential Savings
• Carefully Select a Qualified Telemedicine/Gatekeeper Provider 
• Make Simple Changes to the Employee Benefit Plan Design  
• Put the Plan in place now for the Fall Enrollment and the 2014 Effective Date
• Educate the Employees and their Families about the Value of the Plan; and explain the "Gatekeeper" function 
• As an Employer or Broker/Trusted Advisor, the Employer, and the Employees/Families will experience an enhanced, cost-saving, Plan with Greater access to trained physicians.

What's Next - (1) As an Employer (2) as a Broker                           

          1) Employers -- Use the ROI Calculator!  Whether you are Self-Funded or Fully Insured, contact us to utilize the ROI Calculator - there's No Cost.  You can see the value of moving forward with a Telemedicine Plan and even better - utilizing the Plan as a Gatekeeper.  You can: (1) Substantially Reduce Health Plan Costs, (2) Reduce Unnecessary Doctor and Emergency Room Visits, (3) Dramatically Improve Employee Access to Healthcare Professionals, (4) Reduce Lost Employee Work Time and Absenteeism.  Employers have realized triple digit returns on their investment during the first 12 months.   

          2) Brokers - Use the ROI Calculator and see what it would do for your Clients.  You can save your Current and Potential Clients substantial Dollars (2) Improve the Employees and their Families Health Care, (3) Gain Employees and their Families immediate access to Emergency Trained Professionals, (4) Retain and Attract Employer and Individual Clients.  Employers have realized triple digit returns on their investment during the first 12 months.     

Contact BenefitPlace.biz now to utilize the Telemedicine/Gatekeeper Calculator.  We'll walk you through the process.  Within less than an hour, you can see the value! 

Email - max@benefitplace.biz   Call - 216.577.5579 to schedule an an ROI Calculator Demo!

COST SAVING SOLUTIONS FOR GROUP HEALTH PLANS THAT ASSIST EMPLOYERS AND EMPLOYEES

A Custom Combination of 24/7 Expert Medical Advice

From Trained Emergency Professionals and

Professional Strength Medical Supplies
Providing a Verifiable ROI!

With years of experience in providing remote medical services, MedCallAssist is the

perfect partner to help alleviate the stress & financial burden associated with protecting your employees or group members and their families from medical concerns.

You can utilize all of our services or just a portion of them to have a healthier workforce or member base. In many cases, we’ll design a program that maximizes safety and convenience while limiting overall expense for the employer or group. In other cases, we’ll design a program that caters to the needs of your group and provide assistance with offering the program to your employees or members.

• Custom program tailored to your needs; Provide it to your staff/members or
let them purchase it
• By diagnosing and treating a problem early, you can save lives and prevent
unnecessary hardship
• 24/7 access to physicians and medical advice on treatment, care facilities,
or transportation providers
• Custom-designed, professional-strength medical supply kits with refillable
medications
• Vast network of medical care and transportation providers to ensure the right
service and the right price
• Reduce health-care expenses by decreasing ER visits by up to 50-70% and
Doctor’s Office visits by up to 20%  
• Addressing medical issues in a prompt way allows you to decrease
transportation costs and specialist visits
• Reduce time away from work by addressing injury or illness in the workplace
promptly and correctly
• Detailed reporting available to employers to better understand and assess the
medical needs of their staff

Click To - Check out Our Plans!                                       Click - Opportunities For Brokers                                                    Click - Opportunities For Employers and Employees                                                             Click - Opportunities For Individuals and Families                                                                                                 Click - Opportunities For Physicians                                                     Visit the MedCallAssist BPTradeShow.com Booth  Contact Maxine Collin at max@benefitplace.biz or  Call 216.577.1307 -- See and Review  an Employer Specific ROI Calculator!

WHAT DOES AN INTEGRATED ADMINISTRATIVE SERVICES ORGANIZATION (ASO) DELIVER?

The Insurance and Benefits Industries have numerous sectors and nuances that are often confusing and misunderstood.  The plethora or acronyms adds to the confusion!  Our goal at BenefitPlace.biz and BPTradeShow.com is to bring some clarity.  One of the sectors is Administrative Service Organizations (ASOs).  To help bring some clarity, we reached out to Aaron Peterson of CenterPoint Solutions Inc. - A Broker friendly PEO/ASO.  He provided the following:      

The Benefit of Using Administrative Services 

These points create COMFORT with client, CONSISTENCY for compliance and implementation purposes, all leading to FASTER SALES CYCLE!

Service Included in package: 
 Process Payroll
 Benefit Deductions
 Wage Garnishments
 All State and Federal Taxes Sent
 Pay Insurance Carriers
 All State and Federal Reports Filed
 Tax Levy Payments
 Federal & State compliance posters
 Administer Family Leave Act
 On-line record of Paid time Off (PTO)

Employees have on-line access to: 
 Paystub and verify hours worked
 Annual W-2
 Health Insurance Summary of Benefits
 Update employee demographics

Facilitate compliance, direct payment of benefit invoices, workers compensation premiums, or state ordered garnishments through payroll deduction in the effort to manage the clients’ cash flow. Agents need only notify clients this is a service provided and complete required documents. Processing payroll is not required; however it makes business much easier in keeping direct payments current for each client.

The ASO will enable the agent to generate additional income from the client. Once implemented, the client will begin to go to the ASO with questions regarding additional needs such as Workers Comp.  Insurance, HR guidance etc. When provided by vendors through the ASO these services could provide residual income.

Guest Blog Provided by  - Aaron Peterson, CenterPointe Solutions Inc.

UNDERSTANDING TELEMEDICINE - THE NEW FRONTIER FOR ACCESS TO PERSONALIZED HEALTHCARE AND COST-CONTAINMENT!

Let's take a close look at Telemedicine/TeleHealth/Mobile Health! (See Below For a List of Providers and our Recommendation).

What is Telemedicine? ATA - American Telemedicine Association, provides "Formally defined, telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status. Telemedicine includes a growing variety of applications and services using two-way video, email, smart phones, wireless tools and other forms of telecommunications technology.

Starting out over forty years ago with demonstrations of hospitals extending care to patients in remote areas, the use of telemedicine has spread rapidly and is now becoming integrated into the ongoing operations of hospitals, specialty departments, home health agencies, private physician offices as well as consumer’s homes and workplaces."  

 Why is there a demand for Telemedicine? According to a Forbes Article of 3/38/13 titled A Ray Of Hope For Affordable, Convenient, Quality Health Care  - "Steven Brill’s recent 24,000-word cover story in Time captured, in demoralizing detail, all that’s wrong with America’s bloated, dysfunctional health care system. How about a ray of hope?

It’s called telemedicine. Say you have symptoms of a sinus infection or the flu, or even need a trip to the emergency room. Rather than wait days for a diagnosis from your primary doc, a telemedicine service can get a bona fide physician on the phone..."   

The article goes on to say that we are at a "Point of no Return" with increased health insurance premiums and popularity of high deductible plans (HDHPs).  In addition to these points, I'd add that the shrinking number of personal care physicians combined with the newly insured population under PPACA will make getting timely appointments with a Doctor even more difficult than it is today. In addition, visits to Doctor's offices or Emergency Rooms are costly and expose the individual to other patient's illnesses.

How Does Telemedicine work? Employee Benefit News (EBN) by Tristan Lejeune  - September 26, 2012 explains "Roga, the CEO of STAT Doctors, discussed how phones, computers and other ways 'physicians [use] technology to treat patients remotely' have the potential not only to lower health care costs drastically, but to change way people see and seek medical treatment. Still, he pointed out, the root of this emerging field is deep in the past."

'What telehealth really is is going back to a house call, Roga said. When providers include telemedicine options in their health plans, he says, those dial-in visits are replacing the physical touching, and keeping to illnesses of low acuity, but the trade is in-home convenience, along with greater reach, improved efficiency and, really, improved coordination of care.

'This model works because you can be seen when you want as quickly as you want,' Roga said, pointing out what an asset this is for a society in love with instant gratification. He considers telehealth benefits as a great 'turn-key solution for the employer,' coming at no cost to them while providing the most accessible kind of care."

Is There Demand and is it Growing?  According to a Survey by the  Mercer Cosulting firm, 15% of major employers offer some form of telemedicine, while an additional 39% are considering the option. 

The Wall Street Journal adds ((Wilde Mathews, Wall Street Journal, 12/20) / ihealthbeat) "Insurers and businesses say telehealth technology could help alleviate the projected shortage of primary care physicians. In addition, remote physician consultations typically cost about $40 to $45, significantly less than visits to an emergency department or urgent care center, as well as most in-person doctor visits."

Tower Watson reports: "Large employer offering telemedicine services - Employers are beginning to insist on coverage of teleconference consults, as well as for the medical equipment that is sometimes needed to remotely  monitor certain types of patients — cardiac cases, for instance — who might otherwise be hospitalized for monitoring.

Some of the largest employers who have their own health centers are adding or will soon offer telemedicine services. A Towers Watson survey of onsite health centers this year said 28 percent of employers will offer telemedicine benefits by the end of next year, up from 8 percent now."

Does Telemedicine save money?  Wikipedia reports on a study from Britain, "The UK’s Department of Health’s Whole System Demonstrator (WSD) launched in May 2008. It is the largest randomised control trial of telehealth and telecare in the world, involving 6191 patients and 238 GP practices across three sites, Newham, Kent and Cornwall. Three thousand and thirty people with one of three conditions (Diabetes, Chronic Heart Failure and COPD) were included in the telehealth trial. The trials were evaluated by: City University London, University of Oxford, University of Manchester, Nuffield Trust, Imperial College London and London School of Economics.

• 45% reduction in mortality rates
• 20% reduction in emergency admissions
• 15% reduction in A&E visits
• 14% reduction in elective admissions
• 14% reduction in bed days
• 8% reduction in tariff costs"

Who pays for the Telemedicine Plans?  While to date Employees generally pay for the Plans, some Employers are paying for all or part of the cost. The plans are also available to individuals and their families. As data on the ROI for Fully Insured and Self-Funded Groups becomes available, more Employers will fund all or part of the cost to drive down health plan costs and reduce absenteeism. In addition, more Individuals and their Families will pay for the Plans to reduce out-of-pocket costs incurred due to increased co-pays and deductibles on their health plans.

How do the Telemedicine Plans differ? The Plans offered by the Providers and Brokers differ by the quality of services provided and by cost. Our research determined that buyers generally "Get What They Pay For". Budget Plans provide limited access and limited services! To gain the desired services and ROI, we suggest examining the Plan's features and benefits before purchasing. The following questions to ask providers should assist in the decision-making process: 

A) Does the Provider perform a health history for each participant to assist with diagnosing?

B) Is the Service Internet our Phone Based?

C) Is their immediate access to Physicians?

D) Do Physicians follow-up after the original call?

E) Do they offer a Prescription Medical Kit to assist in immediate treatment? 

F) Is there an additional per call charge in addition to the monthly fee? 

G) Is there a Deductible and/or Co-Pay?

Who offers these Plans? For a directory of listings, Telemedicine.com provides access to a Directory.  While this directory lists numerous organizations offering a variety of Telemedicine Plans - US based and International - our research has isolated six basic choices (it should be noted that several of these Organizations offer their Plans through Brokers/Consultants who rename and Brand the Plans to their agency):

1) AmeriDoc

2) Consult A Doctor

3) GetMedCallAssist*

4) HealthCare Magic

5) InteractiveMD

6) TeleDoc

*Who do we recommend? Based on our objective analysis - taking into account the features and benefits listed above - GetMedCallAssist (GMCA) provides the broadest range of services at the Best Price with the greatest potential ROI!

Get more information about GMAC:

• As a Broker
• As an Employer
• As an Individual or Family
• As a Physician

BenefitPlace.biz has created sections on its website dedicated to Describing Telemedicine Plans and Listing Providers and Brokers of the Plans. We invite our readers to comment and add to the Information and Providers. For more information - Email max@benefitplace.biz or Call 216.577.5579.

YOUR GUIDE TO A SUCCESSFUL PRIVATE EXCHANGE

Structuring and offering a Private Exchange to assist Employers, Employees, and Individuals in the decision-making processes requires a new set of tools and the proper choice of directions!

Private and Public Exchanges - A new Employee Health Insurance/Benefits Distribution Channel
PPACA/Obamacare has delivered disruptive changes to the Insurance and Employee Benefit Industries. What were familiar distribution channels for Carriers, Brokers, TPAs, Enrollment Companies, and Employers are now changed forever.

As a new health insurance distribution channel, the Public Exchanges are one of the most misunderstood and confusing parts of healthcare reform. There are basically two types of Exchanges:

1) Public - State and Federal Health Insurance Exchanges - exclusively for health/medical insurance coverage. According to the Henry J. Kaiser Family Foundation, www.kff.org, "Exchanges are new organizations that will be set up to create a more organized and competitive market for buying health insurance. They will offer a choice of different health plans, certifying plans that participate and providing information to help consumers better understand their options.

Beginning in 2014, Exchanges will serve primarily individuals buying insurance on their own and small businesses with up to 100 employees, though states can choose to include larger employers in the future. States are expected to establish Exchanges--which can be a government agency or a non-profit organization--with the federal government stepping in if a state does not set them up. States can create multiple Exchanges, so long as only one serves each geographic area, and can work together to form regional Exchanges. The federal government will offer technical assistance to help states set up Exchanges." 

The Public Exchanges have the option of including Employers with more than 100 Employees beginning in 2017. Mid-size and large U.S. Employers are exploring alternate health care models - such as Private Exchanges and Self-Funding to deliver high-quality, cost-effective health care plans to their employees. 

2) Private Exchanges for Group/Individual Health Insurance and Employee Benefits - including Voluntary/Worksite and Ancillary Plans. These exchanges are marketplaces that connect Employers, Employees, and Individuals with the providers of Plans, Programs, and Services. According to Booz and Company "The value proposition of private exchanges differs from Public exchanges in some important ways. First, private exchanges are flexible and can be customized to address the needs of any employer group, unlike public exchanges, which are targeted to individuals and small groups. For instance, private exchanges can design benefits tiers specific to employer segments with robust multichannel employee decision support. Another advantage is that private exchanges can offer a broader range of retail products, such as dental and life insurance and even non-insurance products, than public exchanges can."

The Concept of a Private Exchange is not new! Private Exchanges are essentially the old Cafeteria/Flex-Plans on steroids powered by technology! The Broker provided a "Menu" of benefits. What makes the New Private Exchanges different from Cafeteria/Flex Plans?  The differentiating factor is the use of web-based technology for the Education, Communication, Enrollment, and Supporting Data Management. Emerging technologies have made it possible to mass-customize Individual Insurance and Employee Benefit Plans. This enables the Brokers, Consultants, TPAS, Enrollment Companies, and Employers to utilize multiple Carriers as well as a choice of Plans, Programs, and Services with efficiency and cost-saving. 

Combining Private Exchanges with a Defined Contribution Employee Plan Design Creates New Opportunities for Brokers and Employers! A white paper by Booz and Company stated the following: "Over the past decade, this model has come under increasing strain as healthcare costs have more than doubled, creating an affordability crisis for employers. Now the problem has reached a tipping point. Some employers are considering a paradigm shift to their health benefits strategy that’s akin to the transition from pension plans to 401(k) accounts: switching from defined benefits toward a defined contribution model. Instead of designing and offering defined health benefits, companies make cash contributions to savings accounts that employees use to purchase insurance products of their choice. This model allows the company to cap its healthcare cost at a desired threshold, improving control of current expenses and future liabilities." 

Current status in the development of Private Exchanges.  To date their appears to be four basic ways Private Exchanges are being created and offered:

1) Software companies have developed platforms for providing Brokers and Employers the technology required to establish Private Exchanges. The platforms are being sold as a Product or Service to the Insurance and Benefits Industries.

2) Technology companies have developed the software and are acting as the Broker for offering the Carrier/Providers Plans, Programs, and Services on the exchange platform. In most cases the companies are marketing directly to Employers. In some cases, they will partner with Brokers or license the technology.

3) Several large Brokerage Firms have created Private Exchanges utilizing either proprietary or purchased technology to provide a platform to their current and potential Clients. 

4) Companies like BenefitPlace.biz are developing platforms that take advantage of several software and technology opportunities making the platforms available to Brokers of all sizes. This permits the Broker to retain control of their Employer Groups and to build the "Menu" of Insurance and Benefits. This opportunity provides a choice of platforms to meet the requirements of different sized Employer Groups in various industries - Small Group Market; 50 to 500 Employees, and the Larger Group Markets. The Broker works with the Employers on a case-by-case basis to determine the plan designs that best meet their needs, ie. Fully Insured, Self-Funded, Defined Benefit, Defined Contribution, etc. In addition,the Broker can select the appropriate technology by Price and Complexity. The following Graphic should help explain how this platform works and its components:   

  

Offering Employers, Employees, and Individuals the opportunity to make Insurance and Benefit related decisions utilizing a Private Exchange is the new frontier in distribution. It is our feeling at BenefitPlace.biz and BPTradeShow.com that Brokers should remain the guide and Trusted Advisor to the end-user consumers - Employers, Employees, and Individuals!

If you have questions about the above, please Email - max@benefitplace.biz or Call 216.577.5579

BROKERS - SUCCEEDING AND PROFITING IN 2013

For Insurance/Benefit Brokers to Succeed and Profit in the Employee Benefits Markets - as well as Individual Markets - in 2013 and Beyond their product lines must include:

• Health Coverage
• Voluntary/Worksite Plans
• Ancillary Plans and Services

Changes in Plans, Programs and Services offered will be required.  PPACA/Obamacare - complemented by the plethora of guidelines and regulations rolling-out from HHS, DOL, EBSA, IRS, and other Federal as well as State Agencies - are dictating required changes. They are also causing confusion and new needs for Employers, Employees, and Individuals to better Control Risk.

Most of the media and dialogues to date have focused on issues related to compliance with PPACA! It is our position at BenefitPlace.biz and BPTradeShow.com that while Brokers must understand and be diligent about assisting Employers, Employees and Individuals with compliance and PPACA, their success and profit resulting from working with Clients will be the result of other components. These include:

1. Focus On Offering Value-Added Services - Becoming the Trusted Advisor to Employers, Employees, Individuals and the Families involved. 
2. Offer Employers, Employees, and Individuals Strategies and Solutions for dealing with PPACA. These include: Access to Private Exchanges; Creative Plan Designs including: Self-Funding; Defined Contribution; Captives; and more.
3. Integrate Compliant, Existing Plans, Programs, and Services with New Opportunities available under PPACA guidelines. These should include: Federals and State Exchanges, SHOP Plans for small Business, Tax Credits, Subsidies, and more.  
4. Offer a Broad Spectrum of Plans, Programs, and Services available utilizing the Best-of-Class Carriers and Providers to meet the needs of Employers, Employees, and Individuals within their price-points. Many compliant opportunities should be considered by the Broker. These include: Health Related Plans -Traditional Health Plans, Self-Funding, HDHPS/CDHPs, HRAs, Limited Benefit Plans, Concierge Services, Telemedicine/Telehealth, and more. Voluntary Plans - Dental; Vision; Short Term Disability (STD), Long Term Disability (LTD); Life Insurance, ie. Term, Whole Life, Universal Life, Annuities, etc.; Critical Illness; Cancer, Hospital Income; Legal; Pet; and more. Ancillary Plans - Discount Plans, Pet, Rx Cards, and more.   
5. Take Advantage of Tax-Advantaged Opportunities to assist in reducing costs while increasing the participants ability to mitigate risk. The following should be considered for utilization: Section 125 Premium Conversion; Reimbursement Plans - Health/Medical; Dependent Care; Transportation/Parking; HRAs; HSAs; Retirement Plans.
6. Focus on Empowering the Employers; Employees and their Families; and Individuals/Families with Insurance and Benefits related information on an ongoing basis. The message must be simple and understandable explaining their choices of Plans, Programs and Services. To accomplish this Brokers and Carriers will need to leverage  the Power of the Internet, participate in Social/Business Media; Mobile Messaging; and more. 
7. Utilize Technologies to Assist in the Education, Communication, Enrollment and Data Management Processes. Affordable technology takes the burden out of the Insurance and Benefits decision-making process by structuring and implementing appropriate and efficient Enrollment Capacities. Depending on the size, industry, and desires of the client, these methods should be conidered: Paper; Face-to-Face/One-on-One utilizing laptop software; Internet Based; Kiosks, and more. 
8. Restructure Revenue Sources to include both Commissions and Fee Based Revenues. Commission from traditional Health Plans have been reduced or are disappearing. Voluntary/Worksite and Ancillary Plans are a great opportunity to for Brokers too increase revenues and better meet the needs of Employees and Individuals. A shift to Fee Based Platform will assist in paying for the value-added services required in this new marketplace. Employers, Employees, and Individuals are accustomed to paying fees for many other services, these include: Legal, Accounting, Tax Services, Financial Planning; Investments; Cable, and more. 
9. Create Strategic Alliances with other professionals to provide Employers, Employees, and Individuals (including families), a broader spectrum of services. The following should be considered: TPA Services for Employers; PEO or ASO Services for Employers; Payroll Services; Income Tax Preparation; Accounting/CPA Services; Legal Services; Financial Planning; Retirement Planning; and more.
10. Focus on Delivering a Verifiable ROI (Return their Invested Benefits/Insurance Dollars)  to Employers, Employees, and Individuals.

In addition to the above, Brokers must streamline operations, become more efficient, and reduce wasted expenditures while at the same time becoming more effective to preserve scarce financial resources. Areas of focus should include:

• Utilization of Emerging Technologies!
• Outsourcing or Partnering to Deliver Client Services!
• Optimize and Revamp Websites - including Landing Pages - to attract visitor traffic.  Websites should not be a Billboard in the Desert!
• Reducing Wasteful, Inefficient, and Unproductive Outbound Marketing, including: Printed Media Advertising; Printed Brochures; Buying Lists, Call Centers, Cold Calling, Traditional 3 Day Trade Shows, Outings!   
• Increasing Inbound Marketing Efforts - Effectively utilize the Power of the Internet, Search Engines, Social/Business Media, and SEO.  With a minimal investment of dollars - but with consistent and persistent efforts - Qualified Clients will knock on the Brokers doors if they want and need the Plans, Programs, and Services Offered! 

Even if the Broker can deliver all of the above 10 components and change their focus, they must be able to reach-out and let Clients and potential Clients know they have the capacities. Inbound Marketing will Deliver with a Verifiable ROI to the Broker!

For more information about any of the above topics, Email max@benefitplace.biz or Call Phil - 216.577.5579