January 2017 NEWSLETTER
Yes, there's uncertainty, but the evolution will continue
 
According to an Aon Hewitt survey of 800 employers conducted after the presidential election, their top employee benefit concern in 2017 is the employer role regarding the Affordable Care Act (ACA). Employers are particularly concerned about the employer mandate, which includes reporting and disclosure obligations and other requirements.  It is unclear whether these requirements will be dropped, expanded or modified in some way.

J.D. Piro, head of Aon's law group, says that the shear complexity of the ACA will not make its repeal and replacement an easy matter. "This is an interconnected web of laws and rulings, and the ACA affects every sector of healthcare. It's thousands of pages of regulations. Repealing it is not as easy as turning off a light switch or unplugging a computer and plugging it back in again."

Tom Daschle, the former Democratic Senate majority leader who helped craft the ACA, said healthcare reform "has the potential to swamp any presidential administration because of its complexity and the extraordinary emotional context of people's lives and health." 

Amid all of the speculation about repeal and replace, health policy experts have long been looking at improving pieces and parts of the ACA since its inception. Virtually everyone agrees that changes are needed in today's healthcare industry, especially in areas of quality, transparency, affordability and information sharing.

On the other hand, healthcare transformation that has occurred as a result of technology advancements has a momentum that will be very difficult to halt. For example, we are seeing changes in the way care is delivered that will continue to evolve. Telemedicine, retail clinics, healthcare-related mobile applications and other delivery platforms are becoming increasingly popular with healthcare consumers.

The same is true for payment models. Many large and influential healthcare systems have begun moving away from fee-for-service medicine and are now focusing on total-cost-of-care models. They are also taking responsibility for the health of their patients beyond the hospital and into the community. And paying providers based on outcomes as opposed to the amount of care delivered has spread to private insurers.

One thing is clear. The changes we are seeing will continue no matter what happens in Washington over the next number of years.


Patty Starr
Executive Director
Guest Column

The 21st Century Cures Act: The Most Significant Piece of Healthcare Reform Since the ACA?

On December 13, 2016, President Obama signed the 21st Century Cures Act (the "Act") into law. The Act is being heralded by some as the most significant piece of healthcare legislation since the Affordable Care Act ("ACA"), and includes provisions focused on accelerating drug and device development and approval, behavioral health reforms, Medicare and Medicaid payment policies, language regarding health information technology, and regulations affecting small employers. The Act covers a wide variety of topics that have implications for healthcare providers, employers, and other entities. While this summary does not address all of the Act's provisions, it addresses two areas of focus that have a significant impact on employee benefits.

First, the Act strengthens the enforcement of mental health parity requirements. The Mental Health Parity and Addiction Equity Act of 2008 ("MHPAEA") requires certain health plans to ensure that financial requirements (e.g., copays and deductibles) and treatment limitations that are applicable to mental health and substance use disorder (collectively, "behavioral health") benefits are no more restrictive than requirements or limitations applied to medical and surgical benefits.Because compliance with MHPAEA has generally been deficient, the Act directs the U.S. Departments of Health and Human Services and Labor to issue guidance within 12 months regarding compliance with MHPAEA. Additionally, the Act increases enforcement by mandating that health plans that violate MHPAEA five times will be audited the following year to help improve compliance.

Second, the Act adds a new permissible form of standalone health reimbursement arrangement ("HRA") for small employers, the Qualified Small Employer Health Reimbursement Arrangement ("QSEHRA"), and suspends until after December 31, 2016, the application of an excise tax originally intended to discourage standalone HRAs. Before passage of the Act, under Internal Revenue Service ("IRS") Notice 2013-54, the IRS prohibited standalone HRAs because the IRS interpreted such HRAs to be a group health plan that failed to satisfy certain patient protection provisions of the ACA, namely the prohibition on imposing an annual limit on minimum essential coverage and mandating the provision of preventive coverage at no cost to participants. Under this interpretation, an employer that offered a standalone HRA was subject to an excise tax of $100 per day per employee. 

Under the Act, "small employers" as defined by the ACA (i.e., employers with fewer than te equivalent of 50 full-time employees) may offer a QSEHRA under the following conditions:
  • The QSEHRA can only reimburse actual medical expenses, specifically including premiums for individual health insurance policies. 
  • The QSEHRA must be offered on the same terms to all employees, with limited exceptions.
  • The QSEHRA must be 100% funded by the employer.
  • Reimbursements from the QSEHRA cannot exceed $4,950 for employee-only coverage or $10,000 for family coverage.  These amounts are pro-rated for partial years and will be indexed for inflation in future years.
  • The employer must provide a written notice to its employees at least 90 days before the beginning of the year (or by March 12, 2017, for 2017 QSEHRA arrangements and upon eligibility for individuals who become eligible during the year).  The notice must contain certain specified information.
Small employers considering establishing a QSEHRA should take into consideration that eligibility for a QSEHRA will affect their employees' eligibility for a federal subsidy for individual health insurance through the ACA Marketplace.


Daphne K. Saneholtz is a Partner at Brennan, Manna & Diamond and can be reached at 614-246-7508. 


Health Action Council Programs are diverse, informative and free to Health Action Council employer members. Click on the available links to learn more and register. 

January 10, 2017 
Insights and context to important human performance priorities
Webinar
9:00am - 10:00am

January 19, 2017
Keynote speaker: Fortune Magazine's award-winning Senior Editor-at-Large Geoff Colvin
6:45am - 3:45pm
Nationwide Conference Center
Columbus, OH

News Flash!

Five HRCI and SHRM credits have been approved for individuals who attend the entire Symposium.

January 27, 2017 
The pros and cons of voluntary benefits products and alternatives that benefit your employees
Webinar
12:00pm - 1pm

February 7, 2017
Includes best practices employers are using to comply with HIPAA
Webinar
9:00am - 10am

February 15-16, 2017
Keynote speaker: Zubin Damania, AKA ZDoggMD
Plenary speakers: Medical futurist Rubin Pillay, MD, PhD, and James A. Klein, president of the American Benefits Council
Huntington Convention Center of Cleveland
Cleveland, OH

News Flash!

Two SHRM and HRCI credits have been approved for individuals who attend the half-day session on February 15th; seven SHRM and HRCI credits have been approved for attending the full-day session on February 16th.

February 24, 2017
Stories and best practices on how wellbeing can become more than a valued benefit but in reality a corporate strategy
Webinar
12:00pm - 1:00pm

March 2, 2017 
A quick review of the latest compliance issues
Webinar
2:00pm - 3:00pm

March 14, 2017 
A review of payment-reform models
Webinar
12:00pm - 1:00pm

March 31, 2017 
Sorting out the landscape of ACOs, Patient Centered Medical Homes and more
Webinar
12:00pm - 1:00pm


Upcoming community events that may be of interest to Health Action Council members and friends are listed below.

January 10, 2017 - Greater Cleveland Food Bank
Cleveland, OH 

January 26, 2017 - Worldwide Employee Benefits Network
Cleveland, OH

February 7, 2017 -- Better Health Partnership
Cleveland, OH

March 1, 2017 - Health Policy Institute of Ohio
Columbus, OH

April 7, 2017 - Better Health Partnership
Cleveland, OH




Nontraditional Voluntary Benefits Gaining Popularity

Availability of these benefits is way to engage employees across the spectrum  

Employers should be on the lookout for a number of nontraditional voluntary benefit trends that are gaining popularity with employees, according to Elizabeth Halkos, Chief Revenue Officer of Purchasing Power, a specialty e-retailer that offers consumer products, vacations and online education services through convenient payment plans. Increasingly popular nontraditional voluntary benefits include identify theft insurance, financial counseling services, tuition assistance, elder care and egg freezing. Halkos says that nontraditional voluntary benefits can differentiate an employee benefits package in a competitive workforce environment. Read more .

Health Action Council is hosting a webinar - Voluntary Insurance Pays... But Who Benefits? - on January 27th from noon to 1pm.
What's Influencing Medical Cost Trends for 2017? Not Employer Plans.

A recent Health Research Institute study found that medical cost trends for employer-sponsored plans are not rising at the same pace compared to overall healthcare costs. In fact, the study predicts that the medical cost trend in 2017 for Americans covered by employer-based health insurance will be the same as 2016. The study says that forces inflating medical cost trends include an increased access to care - most notably primary care - along with behavioral health services and convenient care delivery. Read more .

Judge Blocks Portion of ACA Nondiscrimination Rule

A judge from the U.S. District Court for the Northern District of Texas issued an order on December 31, 2016 prohibiting the Department of Health and Human Services from enforcing its nondiscrimination rule under ACA section 1557 that prohibits discrimination in health coverage on the basis of gender identity or termination of pregnancy. The remaining provisions of the rule that prohibits discrimination in health coverage on the basis of race, sex, color, national origin, age or disability will take place as scheduled, mostly on January 1, 2017. Read more.

CMS Launches Two New Compare Websites

Websites enhance push for transparency and engagement 

The Center for Medicare & Medicaid Services has launched two new consumer-oriented websites that publish information about the quality of inpatient rehabilitation facilities and long-term-care hospitals. The websites extend the list of CMS Compare websites amid a push in to increase transparency about healthcare quality and to engage patients in their own care. CMS says it will also update the overall quality star ratings on its Hospital Compare website. Read more.
Leapfrog Group Announces Top Hospitals

The Leapfrog Group has announced its 2016 list of Top Hospitals. The prestigious distinction honors the highest performing hospitals on the Leapfrog Hospital Survey. Health Action Council serves as Regional Leader for the states of Minnesota, Ohio and Oregon. Ohio facilities that made the list of Top Hospitals include Dublin Methodist Hospital - Ohio Health; Grady Memorial Hospital - Ohio Health; Marion General Hospital - Ohio Health; Shelby Hospital - Ohio Health; Cincinnati Children's Hospital Medical Center and Nationwide Children's Hospital. Oregon facilities on the list include Kaiser Sunnyside Medical Center and Providence Portland Medical Center. Congratulations to these outstanding organizations! 
Where Does Our Personal Healthcare Spending Go?

Eighteen percent of all personal health spending in 2013 went to diabetes ($101 billion), ischemic heart disease ($88.1 billion) and low back and neck pain ($87.6 billion) along with hypertension and injuries from falls for a total of $437 billion. The majority of personal healthcare spending was associated with non-communicable diseases. Respiratory infections such as bronchitis and pneumonia topped the list of infectious diseases. These figures and other data are contained in financial analysis titled "US Spending on Personal Health Care and Public Health, 1996-2013," published in JAMA on December 27, 2016. Read more.

Health Action Council Joins Action Collaborative

Effort Builds on Momentum of Previous Roundtable Workshops  

Health Action Council is participating in the Action Collaborative on Business Engagement in Building Healthy Communities , an ad hoc convener under the auspices of the National Academies of Sciences, Engineering, and Medicine's Roundtable on Population Health Improvement. T he Collaborative's purpose is to catalyze and facilitate private sector partnerships and actions of business, health, community, and public sectors to work together to enhance the lives of workers and communities by improving the nation's health and wealth.  The Collaborative recently published a resource list of activities at the Intersection of Business and Healthy Communities. Read more.
Be A Healthy Schools Employer Champion!

Health Action Council is partnering with the Alliance for a Healthier Generation's Healthy Schools Program to encourage our school consortium members and employers to engage and support improving the health and wellness of the future workforce. The Healthy Schools Program is a free online framework that provides school leaders with an evidence-based approach to creating healthier learning environments annually. This is done by developing a wellness council, completing a comprehensive school assessment, developing an action plan, and implementing new policies and healthier programs.  We encourage you to  be a Healthy Schools Employer Champion by adopting a school near your worksite or where many of your dependents attend school. P lease contact Camille Mihalic or call her at 216-236-0372.
Asking Patients about Social Needs Leads to Health Improvement

An analysis by Health Leads, a Boston-based nonprofit founded 20 years ago by a Harvard undergraduate shows that when primary care patients get help attaining basic resources -- such as food, housing, heat and access to affordable medicines -- it leads to improvements in their blood pressure and cholesterol levels. The findings, published in JAMA Internal Medicine, appears to be further evidence that focusing on patients' unmet social needs are a critical pathway toward true health. Read more
 
Health Action Council is a not-for-profit 501(c)(6) organization representing mid and large-size employers that enhances human and economic health through thought leadership, innovative services and collaboration. It provides value to its members by facilitating projects that improve the quality and moderate the cost of healthcare purchased by its members for their employees, dependents and retirees.
 
Health Action Council also collaborates with key stakeholders - health plans, physicians, hospitals and the pharmaceutical industry - to improve the quality and efficiency of healthcare in the community.
Special thanks to our premium annual supporters for sharing Health Action Council's vision and collaborating with us to provide outstanding services to our members.

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