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Employee Benefits and the New Health Care Landscape: How Private Exchanges are Bringing Choice and Consumerism to America's Workforce

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Employee Benefits and the New Health Care Landscape: How Private Exchanges are Bringing Choice and Consumerism to America's Workforce

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  • Real healthcare and benefits reform, real innovation: the complete guide to the fast-growing private benefits exchange industry
  • Leveraging the lessons of the online shopping revolution to drive breakthrough innovation in the benefits industry
  • Case histories, design principles, social and economic implications, business practices, and more


  • Copyright 2018
  • Dimensions: 6" x 9"
  • Pages: 288
  • Edition: 1st
  • Book
  • ISBN-10: 0-13-466530-9
  • ISBN-13: 978-0-13-466530-6

2018 International Book Awards Finalist in "Business and Management" Category
We shop for everything else online…why not benefits?

Using private benefit exchanges (a.k.a. “online benefits marketplaces”), employers can bring a consumer-centric online shopping experience to benefits. Alan Cohen, a benefits technology pioneer, details how these platforms can offer unprecedented flexibility and choice to employees, revolutionize the way employers attract and retain talent, strengthen cost control in an era of skyrocketing premiums, and promote much-needed innovation in the U.S. health care system.

Discover How To

  • Make sense of today’s challenging benefits landscape and plan breakthrough changes that have succeeded for thousands of employers of all sizes
  • Leverage the lessons of the online shopping revolution to drive radical innovation
  • Incorporate the 7 key pillars of a true private benefits exchange into your benefits mindset
  • Gain indispensable practical insights from early adopters’ experiences
  • Clarify the new roles of employers, HR, insurers, brokers, employees, and other stakeholders
  • Accelerate your transition away from inefficient employer-managed plans
  • Assess the ongoing impact of health care reform, public exchanges, health care consumerism, and other trends

Alan Cohen created one of the first private exchange platforms and has pioneered this approach for more than a decade. Now, in a candid discussion of how the economic principles of choice, consumerism, and defined contribution are at work in an exchange environment, he breaks down the concept for HR professionals, entrepreneurs, brokers, insurers, health care reformers, policy makers, and employees. Cohen looks to social and economic implications to forge a future in which all eyes are on a new model of the consumer for the benefits age.

With insights from industry veterans, Employee Benefits and the New Health Care Landscape brings a fresh perspective to the debate on health care and health insurance in America.

Sample Content

Online Sample Chapter

Building a Better Benefits System

Table of Contents

Introduction     1
Attracting and Retaining Employees     3
A New Paradigm Shift for Benefits     5
The Exchange Evolution     8
“Try It, You’ll Like It”     9
Overcoming the “Wait and See” Mindset     11

Chapter 1  Building a Better Benefits System     15

Principle #1: Give Them Money and Let Them Shop     19
Principle #2: Provide True Price Transparency     23
Principle #3: Provide Meaningful Choice     24
Principle #4: Offer Guidance in the Form of Decision Support     27
Principle #5: Optimize the Shopping Experience     29
Principle #6: Ensure a Cultural Fit Within the Organization     33
Principle #7: Refine, Iterate, and Improve     33
Chapter 2  Benefits: The Accidental Entitlement     35
Not Really an “Exchange”     38
“Modern-Day” Insurance     40
Benefits as Compensation     41
So Where Does This Leave Us?     46
Brokers Join the Bandwagon     49
Chapter 3  They Don’t Know What They’re Missing: Flipping the Status Quo on Its Head     51
The Problem with the Status Quo     53
Disrupting the Status Quo     56
    Meaningful Choice     57
    Price Transparency and Defined Contribution     59
    Personalization     67
    Consumerism     70
Chapter 4  Making Sense of Benefits Solutions: Public Exchanges and Private Exchanges     75
The View from the Top: Public Versus Private Exchanges     75
Who Runs These Things Anyway? Types of Private Exchange Operators     79
    Pure-Play Providers     79
    Benefits Providers     80
    Benefits Advisors     80
    Traditional Benefits Administration Companies     81
What Should You Consider When Moving to a Private Exchange?     83
    Single- Versus Multi-Carrier Exchanges     83
    Self- Versus Fully-Insured Models     84
    Funding Strategies     86
Who Can Benefit from Private Exchanges? Markets Served     86
A Look at Products in Private Exchanges     89
What Else Can Private Exchanges Offer?     95

Chapter 5  Employers Find Skin in the Game     99

A Big Bet Pays Off: TitleMax, Part of the TMX Finance Family of Companies     100
Customer-Focused Luxury Resort Gives Back to Its Employees: Sandestin     104
Chapter 6  Six Questions to Ask Before You Choose a Private Exchange     109
What Makes for a True Private Exchange?     111
    1 Is Elasticity Built into Its Foundation?     113
    2 Does It Include Decision Support and Educational Tools?     114
    3 Are Prices Transparent?     116
    4 Does It Integrate with Value-Added Services?     118
    5 Does It Provide Year-Round Support?     119
    6 To What Extent Does It Handle Benefits Administration?     120
Chapter 7  Brokers and Exchanges: Better Together     123
Rick Strater, Arthur J Gallagher & Co     127
    The Role of the Broker     128
    Overcoming Misconceptions     128
        Employees Don’t Care About Choice     128
        Cost Is All That Matters     129
        Defined Contribution Is “Cost Shifting”     129
Rob Harkins, Willis Towers Watson     130
    The Changing Role of Brokers     131
    How Can Brokers Win?     131
    The Role of HR     133
    Technology Is the Future of Benefits     133
Chapter 8  Insurers Find a New Way to Move Product     137
The Private Exchange: A Bridge to the Future?     139
What Insurers Can Gain from Private Exchanges     143
Innovators Embrace Private Exchanges Early On     148
    Jessica Moser, MetLife     148
    Kevin Hill, Oxford Health Plans/UnitedHealthcare     150
Insurers Aren’t the Only Ones Innovating     152

Chapter 9  Innovation in Benefits (Yes, Benefits)     157

Expanding the Aisles in the Benefits Store     163
Letting Individuals Create Their Own Preferred Networks     165
Creating a National Individual Insurance Market     169
Chapter 10  The “Law of the Land,” Insurance Tax Reform, and the November Surprise     175
“The Law of the Land…for the Foreseeable Future”     178
The Viability of the Individual Market     183
What Else to Note on the Legislative Front     185
    The “Cadillac” of Taxes—And Other Pending Legislation     186
    The Medicare Marketplace as a Model     187
    Small Businesses and Individual Benefits Marketplaces     188
    Tweaking the Tax Code     190
Chapter 11  Who’s Afraid of the American Consumer?     193
Some Potential Ways Forward     196
    Tax-Protected Savings Accounts     197
    Employer Funding for Individual Insurance     198
    Consumer-Centric Provider Networks     200
    Data and Digital Tools for Patients and Consumers     201
    Patient-Empowered Healing     204
The Utopian Vision     206
    Shopping for Care     208
        Using a Marketplace to Purchase Non-Emergent Health Care on an As-Needed Basis     209
        An “In-Network” Conundrum?     212
Final Thoughts     213

Appendix A  Private Exchanges 101     217
Appendix B  Making Sense of Benefits Terms     223

Terms Related to Benefits     223
Terms Related to Health Care Consumerism     226
Terms Related to Private Exchanges     227
Guide to Common Benefits Products on a Private Exchange     230
Appendix C  Real-World Data and Applications     233
What Really Happens on Private Exchanges?     233
    Data from the 2017 Private Exchange Research Council (PERC) Analysis     233
What Do Employers and Employees Really Think About Liazon Exchanges?     237
    Data from the Liazon 2017 Employer and Employee Surveys     237
    The Exchange Experience: A Look at How Benefits Are Selected on Liazon Exchanges     240
    For the Benefits Geeks: A Health Care Timeline     246
Index     251


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