Jennifer Webb

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- A policy requirement that employers with more than 200 full-time employees must enroll their employees in a company health plan may not take effect until 2015. 

The Department of Labor (DOL) announced that its guidelines governing automatic enrollment will not be ready in time. Employers will not be required to comply with the provision, which was designed to increase the insurance pool, until after the rules are issued. And the clock is ticking. 

The delay in the automatic-enrollment feature provides "welcome relief" to employers balancing other concerns and regulations of reform, according to New York City-based Buck Consultants. Health insurers would likely find the auto-enrollment an advantage as the market grows. 

"An opt-in provision is actually pretty cheap," she says. "It's much easier to assume everyone's in. There are fewer administrative costs." 

Employers now consider that employees who fail to opt in to coverage have waived the company benefit. However, once the new regulations take effect, the reverse will be true. The law allows employers to wait up to 90 days before enrolling new employees, who must be given adequate notice and an opportunity to opt out of the plan. What level of coverage employers must provide is expected to be part of the DOL guidance. 

Full-time employees work an average of 30 hours or more per week. Employers who don't comply will face a penalty. Employers will have to look at their individual circumstances to determine whether the penalty is more or less than providing health insurance coverage itself, Udow-Phillips says.  

"It's a wage issue," she says. "Employers have to do the calculations themselves, but it's complex and there are many different situations." 

Articles

A policy requirement that employers with more than 200 full-time employees must enroll their employees in a company health plan may not take effect until 2015.

Auto-enrollment provisions direct new members into benefit pool

A Leavitt Partners study has identified 164 entities that thus far have identified themselves as Accountable Care Organizations (ACOs) or have adopted the basic tenets-such as financial accountability for the healthcare needs of a population, managing the care of that population and bearing that responsibility at an organizational level. It's too early to tell how many of these entities are following the Medicare Shared Savings Program or have created unique arrangements instead.  

To date, there is no consensus regarding which models are best. In fact, the study's authors, who created the list by sourcing news releases, media reports, trade groups, collaborations and interviews through September, acknowledge the limitations of its data. A group could define itself as an ACO even without any active accountable-care contracts. 

Surprisingly, hospital systems sponsor the overwhelming majority of ACOs identified by the study. Of the 164 ACOs, 99 are sponsored by hospital systems, with 38 by physician groups and 27 by insurers.  

Croshaw says he was surprised that hospitals appear the most eager to set up ACOs even though they would seem to be the most reliant on traditional, fee-for-service systems.  He attributes that trend to hospitals' fear of being marginalized as competitors acquire physician practices and partner with other providers. 

"Large, fixed-cost businesses do not have the ability to adapt quickly to a changing payment system," Croshaw says. "There's a substantial risk of being isolated and marginalized as these teams form. As one team forms in a given hospital referral region, it seems to be spawning additional teams that don't want to be left out of the game." 

That integration of care offers additional negotiating leverage, even if the ACO movement stumbles, he says. 

All of the ACOs are in 41 states, but only 144 of 306 hospital referral regions have an ACO, suggesting that competing health systems are creating ACOs, according to the report. 

Many organizations identifying themselves as ACOs have made only modest changes to the care process, rather than radically redesigning their structure.  

"It appears for now, that defining oneself as an ACO represents an acceptance of the direction the industry has been headed rather than an adoption of a truly new form of care delivery," the report concludes. 

Providers and payers appear to be moving steadily toward an accountable-care model of healthcare delivery, and competitive markets influence the development.

Hospital systems more likely to act as ACO champions

Insurers must invent new healthcare solutions to be competitive in the market emerging under the Patient Protection and Affordable Care Act, according to a report by Accenture. The report claims the most important solution will be attentive, personal customer service that is responsive to diverse and demanding member expectations. 

In other industries, if customers don't experience good service, they vote with their feet, says Doug VanWingerden, senior executive for Accenture Health.  

"They really can't do that today in healthcare, but potentially they can in the future," he says. "When many of these members get thrown into the open-bid exchange market, will they turn around and choose the payer again?" 

Payers need to develop a strong customer service experience now, VanWingerden says, because such transformation takes time. Enrollment for exchange-based products is set to open just two years from now. 

"Building that sense of engagement with the customer is the secret sauce for success in the post-reform era," he says. 

Although payers have invested deeply in customer-service technology, the benefits have been "decidedly one-sided," the report states. Advancements such as automated phone attendants, live chat via the Internet, self-service on a Web site and mobile applications have lowered handling time-but have done little to improve the individual experience. Only 11% of survey respondents said the increased use of technology has improved their level of service over the past five years. 

Meanwhile, most payers continue to struggle with service-experience basics. Customers reported such frustrations as having to contact customer service multiple times for the same reason, dealing with customer-service agents who cannot answer questions, and having to repeat the same information to multiple agents. 

"Money spent doesn't equal customer satisfaction," VanWingerden says.  

Instead, companies need to develop a personal connection with consumers and tailor their experience to meet their needs and preferences. It suggests training customer-service representatives to handle unique needs, such as developing groups experienced in working with new customers or those with specific chronic illnesses. 

"Crafting a personal service experience will only become more important in the post-reform marketplace, given an increased focus on 'patient-centeredness' across the health system as a whole," the report states. 

VanWingerden suggests companies segment their customer base and develop a customer-experience blueprint for each segment. Payers should look at the entire action lifecycle of how customers become aware of health-insurance products, from the media they consume to the Web sites they visit, to how they use and pay for those products, and what sort of experience they have, to define customers' needs.  

"If there are certain aspects of the interaction where basic needs are not met, the customer will complain or switch providers," he says. 

Although cost is important, customers are willing to pay more for good service. Accenture's research shows only 6% of respondents were willing to give up levels of customer service in exchange for a lower price, while 44% opposed lowering quality to save money. 

Payers that help customers use their benefits can develop loyalty and a personal connection, VanWingerden says. For example, an associate might note if a caller has not used her annual mammogram benefit and offer to help arrange one for her.  

Wellpoint's Dan McCoy agrees that customer service is an essential strategy and has worked to organize the company's business, technology, service and information management under one leadership area to more quickly drive change. The company has coached associates to handle calls, avoid transfers and multiple handoffs, and authorized them to resolve issues, he says. Peer-to-peer mentoring helps.  

"You have to make sure they understand how their behavior impacts the customer experience," McCoy says.  

Wellpoint is studying other industries' best practices to understand service expectations, and asking providers about any complaints they hear from patients. 

Insurers must invent new healthcare solutions to be competitive in the market emerging under the Patient Protection and Affordable Care Act, according to a new report.

Jennifer Webb

Articles

Auto-enrollment provisions direct new members into benefit pool

Hospital systems more likely to act as ACO champions

Member service must aim toward individual experiences