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HRAs in 2020: What Can We Expect?

The health reimbursement arrangement (HRA) is having quite a moment.

After being seriously reduced by IRS guidance following the Affordable Care Act, they’ve reentered the scene as a serious option—particularly for small businesses.

With the creation of an HRA in 2016 and two new HRAs on the horizon, it’s a good time to look forward to what’s in store next year.

In this post, we’ll cover everything you need to know about HRAs in 2020. That includes whether your business should consider one, which HRA options will be available, how any HRA rules might change and what’s happening with federal proposals to create two brand-new HRAs in 2020.

Let’s dive in.

Will HRAs be a good option in 2020?

HRAs have always been a good option for businesses that struggle with group health insurance costs. As access to these benefits expand, more and more businesses can consider them as a viable alternative.

This will continue to be true in 2020. The underlying causes of rising health care costs haven’t been addressed, and group health insurance rates will continue to increase while small businesses struggle to meet them.

With the availability of the qualified small employer HRA (QSEHRA) firmly in place—and two new HRAs set to become available in 2020)—small businesses will have a way to control their budgets while offering a formal benefit to employees.

What’s more, the individual market will continue to stabilize, with more insurance carriers returning to and entering public marketplaces. This makes for a fertile field of options for employees who will be shopping for their own policies during the 2020 open enrollment period.

What HRAs will definitely be available in 2020?

While federal proposals recommend creating two HRAs in 2020, the list of confirmed HRAs for the year remains the same as it was in 2019.

They include:

  1. The group coverage HRA. The group coverage HRA is an HRA that operates alongside a group health insurance policy. A business using the group coverage HRA purchases a high-deductible health insurance policy and offers a separate HRA to employees enrolled in the policy. Employees could use the HRA to reimburse themselves for out-of-pocket, non-premium medical costs, including amounts paid toward their deductible.
  2. The one-person stand-alone HRA. As the name suggests, the one-person stand-alone HRA is a stand-alone HRA for businesses with one employee. The HRA reimburses the participant for all HRA-eligible expenses, including individual insurance premiums. To offer the HRA, businesses must have onyl one full-time W-2 employee.
  3. The retiree HRA. The retiree HRA functions much like the one-person stand-alone HRA. All retired full-time employees can participate in the benefit. Typically, only larger businesses offer this HRA.
  4. The qualified small employer HRA (QSEHRA). Created through bipartisan congressional legislation in 2016, the QSEHRA is available to all businesses with fewer than 50 full-time employees. With the QSEHRA, employees can be reimbursed for all out-of-pocket medical expenses, including individual insurance premiums. All full-time employees are automatically eligible for the benefit, and the business can choose to include part-time employees, as well.

If the proposed federal regulations are affirmed in a final rule, we also expect to see two additional HRAs become available to businesses of all sizes.

See also: North Carolina’s Battle for Healthcare Value  

Will any details about these HRAs change?

The group coverage HRA, one-person stand-alone HRA and retiree HRA will all function in the same way in 2020 as they did in 2019. Some details regarding the QSEHRA will change, though.

First, annual contribution amounts will change. Every year, the IRS reexamines the maximum amount businesses can contribute to employees through the QSEHRA based on cost-of-living adjustments. In 2019, these amounts are $5,050 per single employee and $10,450 per employee with a family. The 2020 allowance amounts, which we expect to be released in October or November, will be higher.

Second, if federal proposals on HRA changes go forward, we’ll see new enrollment opportunities for employees with a QSEHRA. Right now, becoming newly eligible for a QSEHRA is not a qualifying life event that entitles an employee to a special enrollment period. Instead, the employee must wait until open enrollment season to shop for and purchase an individual health insurance policy.
With these new guidelines, that will change. If the proposals are enacted in 2020, employees who gain access to a QSEHRA will be able to claim a qualifying life event, which opens a 60-day special enrollment period.

Can we expect new HRAs in 2020?

In October, the departments of the Treasury, Labor and Health and Human Services released proposed regulations that would expand access to HRAs. The most exciting development in the proposals is the creation of two HRAs: the individual coverage HRA (ICHRA) and the excepted benefit HRA.

With the ICHRA, businesses of any size could offer an HRA to employees as a stand-alone benefit. Unlike the QSEHRA, the ICHRA would have no annual contribution caps, and businesses could choose to define eligibility and allowance amount by nine different employee classes.

The excepted benefit HRA would also be available to businesses of any size. Those offering the HRA could reimburse employees up to $1,800 per year for excepted benefits, including dental and vision expenses.

The regulations suggest an implementation date for both the ICHRA and the excepted benefit HRA of Jan. 1, 2020. However, the final rule that would solidify this start date has yet to arrive.
In the meantime, insurance carriers and state insurance departments have been lobbying the departments to push the start date back to 2021 or later. They argue that, because HRAs would allow a significant number of new people onto the individual market, the HRAs could affect their risk pools and the way they structure pricing. Because rates for the 2020 individual market have already been filed, they argue, it would be unnecessarily risky to introduce the new HRAs next year.

See also: How to Optimize Healthcare Benefits  

While we expect the ICHRA and the excepted benefit HRA to become available eventually, we can’t say for certain that they’ll be available in 2020. Subscribe to our blog or check back here frequently to stay updated on all your HRA options for next year.

Conclusion

As in years past, interest in HRAs as a stand-alone health benefit is increasing. In 2020, the HRA will be a great choice for businesses committed to providing health benefits but concerned about cost.

With four strong HRA choices definitely available in 2020 and two more potential candidates, HRAs are poised to help thousands of businesses offer strong health benefits to employees.

For more information about HRAs, check out PeopleKeep’s HRA education page.

There May Be a Cure for Wellness

During my tenure at both British Petroleum and Walmart, I tried various forms of wellness, but to no avail. There were never any savings, participation was low, employees didn’t like it, and administration was complex.

I’ve continued to follow the wellness industry but could never see any genuine success stories. The gratifying news is that I’m not the only one to notice any more. The Los Angeles Times called wellness a scam while Slate just recently called it a sham. And Al Lewis, my co-author on Cracking Health Costs, would say they’re being polite. Most recently, he has noted that the 2016 Koop Award is going to a vendor whose own data shows they made employees unhealthier.

See also: The Yuuuuge Hidden Costs of Wellness  

Speaking of Al Lewis, he has now entered the employee health field directly with Quizzify, which transforms the boring but long-overdue task of educating employees about health, healthcare and their health benefit into an entertaining trivia game. As a colleague and co-author, I have an obvious conflict of interest as I describe my impressions below, so don’t take my word for any of this. Just go play the sample short game right on the website, and ask yourself if you’re learning anything useful, right off the bat. Click here for a link to Quizzify.

Do you think your employees already know this stuff? It’s doubtful. Americans vastly over-consume healthcare; it’s almost free at the point of service once the deductible is satisfied, and they are being bombarded with ads and marketing, as are their doctors. Nothing can solve this massive problem, but Quizzify can help, and is about the only vendor even trying. Backed by doctors at Harvard Medical School and a 100% savings guarantee, Quizzify provides a plethora of shock-and-awe, “counter-detailing” questions-and-answers (with full links to sources) that will educate even the savviest consumers of healthcare and entertain even the dourest CFO. Nexium? Prilosec? Prevacid? You wouldn’t believe the hazards of long-term use. Then there is the sheer waste and possible harm of annual checkups, well-woman visits, PSA tests and so on.

Speaking of hazards, CT scans emit as much as 1,000 times the radiation of an X-ray. Uninformed people are going clinics that will give them a “preventive” CT scan. If a doctor suggested patients have a series of a thousand X-rays for “preventive” reasons, there would be a stampede out of the office.

On the other hand, there are instances where people should go to the doctor but don’t. Swollen ankles? Painless, perhaps, but you may have a circulation problem, possibly a serious one. Blood in your urine, but it goes away before you even make an appointment? That could be a bladder tumor tearing and then re-attaching itself, especially if you smoke. And show me one health risk assessment that correctly advises people over 55 or 60 to get a shingles vaccine if they had chicken pox as a kid.

Then there are the health hazards of everyday life. Those healthy-sounding granola bars are full of sugars cleverly hidden in the ingredients labels. And whoever says vaping is safer that smoking better not be pregnant, because for pregnant moms, incredibly, vaping could be worse for the unborn baby. Just as with the shingles vaccine, chances are your HRA is silent on the texting-while-driving (TWD) issue while obsessing about seat belts, but TWD is by far the more underappreciated hazard.

See also: Wellness Promoters Agree: It Doesn’t Work

Your HRA is probably also silent on the health risks of loneliness, poor spending habits, boredom and most of the other major health risks Robert Woods, PhD, and I describe in our book, An Illustrated Guide to Personal Health. Quizzify has many questions on spending habit, but, if I had one complaint, it would be that (at least in the questions I’ve seen) Quizzify doesn’t address these risks we’ve described in this book.

One of the largest health risks that workers have is being in a job you hate. You won’t see that question on anyone’s HRA either, or in Quizzify. That issue could lead to mass resignations in some pressure cooker companies.

Scores and scores of people have told me they fudge answers on HRAs, anyway. Interestingly, they feel they are on the ethical high ground to do that because of the goofy, nosy and intrusive questions they are asked to answer, e.g., asking about your pregnancy plans in the future. Quizzify, on the other hand, encourages people to cheat. Quizzify wants you to look up the answers because that’s how you learn. So instead of denying human nature, Quizzify channels it.

Conclusion: if you offer old-fashioned wellness, walk, don’t run, to the nearest exit. If you want to look at something that shows huge promise, check out Quizzify.

New Wellness Scam: Value on Investment

What do you do if your entire industry has a negative ROI? If your industry and its lack of ROI have been skewered in the media? If even RAND, which is the most neutral, grownup organization in all of healthcare, now says your industry, wellness, produces no savings and no reduction in utilization of healthcare services? If your leadership group accidentally proved their own industry loses money for its customers? If, on this very site, Insurance Thought Leadership, your patron saint, Harvard professor Katherine Baicker, professes to have no interest in wellness any more, now that her work has been eviscerated?

What do you do if there is a proof that saving through wellness is impossible, and another proof that, even if savings were possible, there haven’t been any? If these proofs are backed with a $1 million reward for anyone who can disprove them?

Here’s what you do: You change the rules so ROI doesn’t matter any more.

The new mantra is “value on investment,” or VOI. The Willis Health and Productivity Survey published this week claims that 64% of employers do wellness for VOI – specifically, “employee morale” and “worksite productivity.” (The survey also mentions “workplace safety.” I guess the workplace is safer if no one is working because they are all out getting checkups.)

But the darnedest thing is, all the data shows that the best way to really get value on your investment is to cancel your “pry, poke, prod and punish” wellness program.

Employee Morale

Have you ever seen employees demand more blood tests? More Health Risk Assessments (HRAs)? More weigh-ins? Quite the opposite. This shouldn’t be a newsflash, but employees hate wellness programs, except for the part where they get to collect employers’ money. As a CEO myself (of Quizzify), I pride myself on our corporate culture. The last thing I would do is force my employees into a wellness program. It would destroy the camaraderie we’ve established.

Obviously, if employees liked wellness, you wouldn’t need large and growing incentives/penalties to get people to participate. Employees dislike wellness programs so much that collectively they’ve forfeited billions of dollars just to avoid these programs.

Anecdotes often speak more loudly than data, and employee morale anecdotes are easy to come by. Simply look at the “comments” on quite literally any article in the lay media involving wellness programs. It’s usually about 10-to-1 against wellness, with the “1” being someone who says: “Why should I pay for someone who’s fat?” or something similar. Or the positive comment comes from a wellness vendor or consultant. You know an industry is bogus when the only people who defend it are people who profit on it.

The weight-shaming involved in wellness programs is, of course, a huge fallacy. Among other things, except at both extremes, there is only a slight correlation between weight and health expense in the under-65 population — the problems associated with weight show up later, typically after people leave the workforce. Assuming major differences among employees would lead to underwriting every individual-marathoners who might get injured, women who might get pregnant, etc. Take the fallacy out, and there is nothing that the American public-left, right and center – is more unified on than detesting wellness.

Workplace Productivity

You’re already pulling people off the line to do the “pry, poke and prod” programs and send them for checkups that are more likely to harm employees than benefit them. So productivity takes a hit to begin with. Add to that the weight-shaming and ineffectiveness of corporate weight-loss programs.

Most importantly, it turns out – according to the Integrated Benefits Institute, a wellness industry association – that the major contributor to low productivity is depression:

chart

Maybe this is just me, but if I were running a company where workers were depressed, I probably wouldn’t try to address depression by implementing a program that workers were going to hate, which is sort of a “the beatings will continue until morale improves” approach to management. I’m just sayin’…

The other noteworthy observation? Anxiety has a big impact on productivity. Wellness programs pride themselves on how many diseases they find. This practice is called hyperdiagnosis. The goal is to scare as many employees as possible into thinking they’re sick. The C. Everett Koop-award-winning Nebraska state wellness program, for example, bragged about how it found that 40% of employees were at risk. However, the program didn’t do anything about the finding, and a year later only 161 employees in the entire state had reduced a risk factor. The vendor, Health Fitness Corporation, also bragged about all the cancer cases it found and all the lives it saved, until admitting the whole thing was made up.

Once again, it’s not clear how a wellness program would reduce anxiety and increase productivity. Or maybe I’m wrong. Maybe there’s nothing like being told you are at risk of dying to really focus you on clearing your inbox before you croak.

Conclusion

Pretending there is a VOI looks to be even sillier than pretending there is an ROI, because wellness neither increases morale nor improves productivity.

All of this brings us back to what we’ve been saying for years-especially on this site, which was willing to post our stuff long before it was popular to do so: Do wellness for your employees and not to them.

The latter doesn’t work no matter what initials you use. But if you want to improve morale and productivity, up your game for perks, subsidize healthier options for food and maybe even directly subsidize a portion of gym memberships. And maybe teach your employees how to spend their healthcare dollars more wisely. (Disclosure: That is the business we are in.)

What do you do if your entire industry has a negative ROI? If your industry and its lack of ROI have been skewered in the media? If even RAND, which is the most neutral, grownup organization in all of healthcare, now says your industry, wellness, produces no savings and no reduction in utilization of healthcare services? If your leadership group accidentally proved their own industry loses money for its customers? If, on this very site, Insurance Thought Leadership, your patron saint, Harvard professor Katherine Baicker, professes to have no interest in wellness any more, now that her work has been eviscerated?

What do you do if there is a proof that saving through wellness is impossible, and another proof that, even if savings were possible, there haven’t been any? If these proofs are backed with a $1 million reward for anyone who can disprove them?

Here’s what you do: You change the rules so ROI doesn’t matter any more.

The new mantra is “value on investment,” or VOI. The Willis Health and Productivity Survey published this week claims that 64% of employers do wellness for VOI – specifically, “employee morale” and “worksite productivity.” (The survey also mentions “workplace safety.” I guess the workplace is safer if no one is working because they are all out getting checkups.)

But the darnedest thing is, all the data shows that the best way to really get value on your investment is to cancel your “pry, poke, prod and punish” wellness program.

Employee Morale

Have you ever seen employees demand more blood tests? More Health Risk Assessments (HRAs)? More weigh-ins? Quite the opposite. This shouldn’t be a newsflash, but employees hate wellness programs, except for the part where they get to collect employers’ money. As a CEO myself (of Quizzify), I pride myself on our corporate culture. The last thing I would do is force my employees into a wellness program. It would destroy the camaraderie we’ve established.

Obviously, if employees liked wellness, you wouldn’t need large and growing incentives/penalties to get people to participate. Employees dislike wellness programs so much that collectively they’ve forfeited billions of dollars just to avoid these programs.

Anecdotes often speak more loudly than data, and employee morale anecdotes are easy to come by. Simply look at the “comments” on quite literally any article in the lay media involving wellness programs. It’s usually about 10-to-1 against wellness, with the “1” being someone who says: “Why should I pay for someone who’s fat?” or something similar. Or the positive comment comes from a wellness vendor or consultant. You know an industry is bogus when the only people who defend it are people who profit on it.

The weight-shaming involved in wellness programs is, of course, a huge fallacy. Among other things, except at both extremes, there is only a slight correlation between weight and health expense in the under-65 population — the problems associated with weight show up later, typically after people leave the workforce. Assuming major differences among employees would lead to underwriting every individual-marathoners who might get injured, women who might get pregnant, etc. Take the fallacy out, and there is nothing that the American public-left, right and center – is more unified on than detesting wellness.

Workplace Productivity

You’re already pulling people off the line to do the “pry, poke and prod” programs and send them for checkups that are more likely to harm employees than benefit them. So productivity takes a hit to begin with. Add to that the weight-shaming and ineffectiveness of corporate weight-loss programs.

Most importantly, it turns out – according to the Integrated Benefits Institute, a wellness industry association – that the major contributor to low productivity is depression:

chart

Maybe this is just me, but if I were running a company where workers were depressed, I probably wouldn’t try to address depression by implementing a program that workers were going to hate, which is sort of a “the beatings will continue until morale improves” approach to management. I’m just sayin’…

The other noteworthy observation? Anxiety has a big impact on productivity. Wellness programs pride themselves on how many diseases they find. This practice is called hyperdiagnosis. The goal is to scare as many employees as possible into thinking they’re sick. The C. Everett Koop-award-winning Nebraska state wellness program, for example, bragged about how it found that 40% of employees were at risk. However, the program didn’t do anything about the finding, and a year later only 161 employees in the entire state had reduced a risk factor. The vendor, Health Fitness Corporation, also bragged about all the cancer cases it found and all the lives it saved, until admitting the whole thing was made up.

Once again, it’s not clear how a wellness program would reduce anxiety and increase productivity. Or maybe I’m wrong. Maybe there’s nothing like being told you are at risk of dying to really focus you on clearing your inbox before you croak.

Conclusion

Pretending there is a VOI looks to be even sillier than pretending there is an ROI, because wellness neither increases morale nor improves productivity.

All of this brings us back to what we’ve been saying for years-especially on this site, which was willing to post our stuff long before it was popular to do so: Do wellness for your employees and not to them.

The latter doesn’t work no matter what initials you use. But if you want to improve morale and productivity, up your game for perks, subsidize healthier options for food and maybe even directly subsidize a portion of gym memberships. And maybe teach your employees how to spend their healthcare dollars more wisely. (Disclosure: That is the business we are in.)

Tips on Evaluating a Wellness Program

This is news you can use.

If you want to evaluate the cost/benefit ratio of a wellness program, the following is a list of costs that are almost always overlooked in wellness evaluations. These are not the only things that need to be evaluated, just the ones most commonly overlooked.

When the items in the following list are fully considered, wellness evaluations can look entirely different.

1. The cost of staff hired to manage the program. A rule of thumb is to multiply their salary times two to account for FICA, benefits, office space, training, workers comp, management, etc.

2. The cost of wages for workers while attending wellness events at work. One company I looked at was spending about $175 per employee per year on this, not a trivial sum.

3. The opportunity cost of the HR staff running the program.

4. The full cost of wellness communications. Sending wellness communications to people at work has a wage cost. See #2 above.

5. The total cost to evaluate the program periodically.

6. The cost of false positives, which come from sending employees to doctors when they’re not sick. This is especially pernicious if you’re paying for wellness exams for employees. At one company, the cost of the false positives, sometimes as high as $80,000 per event, nearly cost more than the physical exams themselves. You have to examine claims data to see this.

7. If you have a fitness center, you need to take into account sports injuries for users. (Understanding this also involves access to claims data.) I’ve evaluated the impact of fitness centers for three very large companies. Taking into account sports injuries, etc., you could not make the case for an ROI for any of the three of them. In one company, we examined claims data on a) moderate or occasional fitness center users, b) people who used the fitness center regularly, and c) nonusers. Nonusers had the lowest average medical costs. Moderate users had higher medical costs than nonusers and regular users had the highest medical costs, a perfect reverse correlation.

Surveys of employees are notoriously unreliable. They measure employee opinions, at best, and opinions are not facts. As we all know, sometimes in employee surveys people will say what they think the surveyor wants to hear.

Medical claims and sick pay data are about the most meaningful ways to measure wellness outcomes. Short- and long-term disability data can be useful, too, as can life claims experience when compared with norms. If you only use employee surveys and other surrogate data, too bad.

I met an actuary who spoke at a conference on this topic and used the measurements above to evaluate wellness programs. He said he’d never seen one that had a positive ROI, except ones that used payroll deduction penalties.

Healthcare at the Tipping Point

The Affordable Care Act, or the ACA, (aka Obamacare) is a catalyst for accelerating change brought about by the crushing cost of healthcare.  We have reached the tipping point where all the players in a $3 trillion industry are desperate to find new footing, while their usual way of doing business is crumbling underneath them.

Don’t get caught up in the rhetoric of politics. Obamacare is just a symptom of the problem; it’s not the cause!

Everything in healthcare is undergoing change. Companies must also change — they must change the strategy, tactics and people involved in their decision-making process. The C-suite understands this better than anyone. They know that in today’s economy taking measured risk is essential for profitable growth. Yet many of them have assigned the responsibility of healthcare business strategy to managers who keep their feet on the brakes, repeating why change is risky every year. That’s why today, in a post-Affordable Care Act world, the strongest C-suites are advocating change for better healthcare strategies, not just safe ones.

Taking Your Foot Off the Brake

One way to do this is to get the C-suite more involved in setting the business strategy direction for corporate healthcare. They need to evaluate the risks associated with the many healthcare opportunities they are facing. One of the first steps in doing so is distinguishing between healthcare risks that can be managed and risks that should be avoided. Avoiding unnecessary costs – like healthcare claims – is where value is created. Here’s why:

The new law under the ACA started as a 2,800-page question mark and now exceeds 28,000 pages. The administration is literally creating and adapting the law as it goes forward. The revisions and updates have been numerous, and they will continue. That’s because the medical treatment industrial complex, also known as the healthcare industry, is one of the largest components in our economy — with a system built on illness and sickness as the revenue model.

But we know beyond a shadow of a doubt that our sickness care model is totally unsustainable. Yet shifting hospitals and physicians practices away from a fee-for-service model, where they receive payments based on the volume of care delivered, will take years to become the norm.

The incentives in our current system are so perverse that hospitals and physicians receive even greater compensation when preventable infections and injuries are allowed to take place. Lest you think this is a harsh criticism, these facts are validated by government studies that indicate medical errors rank as one of the top five leading causes of death in America. Yet we rarely hear anything about these facts.

Healthcare exists on a continuum. On one end, we have buyers who want health insurance only so that a third party will pay their claims when they want or need treatment — like a buffet. On the other end, are people who are looking for an emergency backstop in the event of an unforeseen illness or accident. It should be obvious; there is no one-size-fits-all solution!

Businesses need to take steps to reduce, control and eliminate claims from their healthcare budgets. It all starts with corporate culture and the realization that employers must change the parent-child healthcare dynamic. The parent-child relationship exists where businesses still decide on what benefits, designs and choices there will be for the next 12 months and then tell all employees that this is what the company has selected for them.

It’s time to consider a benefits partnership where the company facilitates the framework for the offering, but the employees choose what fits best for them. The communication resembles something more like “we are partners in healthcare, and each of us will be rewarded for the good health of our team members.” Contrast that against the usual legacy approach where employees are told “here is the new insurance coverage, go and consume because a third party pays the bill and good luck if you get sick — hope you catch it early!’

Three Ways for Organizations to Use the Affordable Care Act

1.  Challenge the status quo legacy thinking of your benefit managers. The easiest way is to put a question mark at the end of their statements.

Ask them to explain the what, why and how of the latest rate increase. Be honest, benefits is not their only job responsibility, and you can’t afford the learning curve after Obamacare. Top line revenue challenges, increasing operational expenses, shrinking margins and profits are the norm today. Reacting every 12 months to the supply chain’s rate increase is not how to manage healthcare after the ACA.

Pop quiz: Do you think the benefits manager hires a broker/consultant that challenges her fear of change, or supports the status quo?

Ask managers to explain why you have prepaid premiums versus a pay-as-you-go strategy. Ask them to explain the  carrier’s rationale for another rate increase. Ask them how the broker/consultant proposed to reduce claims by 20% to 40% in the renewal meeting.

2. How are you identifying, measuring and managing the modifiable risk factors in your employee population

You can’t manage what you can’t measure. The ACA allows employers to create plan differentials where employees can qualify for different levels of benefits based on the outcomes of their biometric screen. For example, smokers who have high glucose, HBP and high cholesterol may pay higher out-of-pocket costs compared with the employee whose measurements qualify for a higher level of benefits. Think of it as finally being able to receive better health insurance because you receive the equivalent of a “good driver discount.”

Additionally, health promotion and preventive care is emphasized under Obamacare, whereby employees can become eligible for incentives based on their participation, activities or outcomes in specified programs.

The ACA provides incentives for promoting health — and not insurance!

3. Define for yourself why you invest in health insurance. Are you only concerned with managing a budget and trying to keep a lid on costs? Is health insurance just a financing cost so employees can access care and a third party will pay most of the bills for them?

Or, do you invest in health insurance so employees will have quality healthcare at a fair price where they can become good healthcare consumers armed with cost and quality resources. Employees can accumulate their own prefunded healthcare accounts through HSAs instead of paying health dividends to insurance companies. For too many employers, insurance companies profit off the  good health of the employees and then charge the company another rate increase every year.

The business of healthcare will never be the same after Obamacare. There is no way to avoid change; you’re either moving forward or going backward. Companies must look for new directions with new eyes and a new map because the old map was so 28,000 pages ago.

The new law provides many tools for controlling healthcare costs by promoting prevention, transferring risk where appropriate and avoiding risk entirely by eliminating adverse selection. Focus the conversation on how to reduce the demand for healthcare claims because that represents 85%-90% of the money invested in healthcare.