Building Engagement: Making HDHPs and HSAs a Success

Building Engagement: Making HDHPs and HSAs a Success

Webinar Transcript:

I'm Jennifer Benz and I am thrilled you are with us today. This is the third of our Master Class Series. We have been super excited about the response to our webinar and I am delighted you are with us today.

If you haven't already, you can sign up for our other webinars on our website. Our next two are coming up over the next few weeks and all of them will be available to download and watch after the live event. You can go back now and watch the first two webinars if you missed those.

Today we will do Q&A at the end of the session. You can type in your questions into the question module on your screen at any time. We will also continue the dialogue online through our blog and articles on LinkedIn and so forth. We want these webinars to be really valuable to you so please give us your feedback and please ask questions and let us know how we can help. And also, again, the slides will definitely be available at the end of the session that's always everyone's number one question.

So let's dive in. Today we are going to start with a little bit of background and context about health savings accounts (HSAs), high-deductible plans, consumer-driven health plans (CDHPs), and everything that is going on and we're going to talk through some employers case studies and walk through our best practices and the formula we've created to really make these plans a success.

Consumer confidence in these and their comfort in these plans are growing. A little over 50% of folks are very or somewhat likely to recommend a high-deductible plan to a friend or coworker.

With that background, let me start with defining consumer-driven healthcare (CDHP). There are a lot of terms that are thrown around and when we talk about it today what we're talking about is really a shift to a new mindset on how we use healthcare and how we manage healthcare expenses.

Consumer-driven healthcare (CDHC) overall is much more than an enrollment in a health reimbursement account (HRA) and in the health savings account (HSA) plan. We are talking about all the components that go along with being a smart consumer and making smart decisions with your health care. And this is really about learning a lot of new habits and new skills that we need to help teach employees. That's everything from discussing treatment options with doctors to opting in to disease managements programs, changing their health habits, managing expenses, and so forth. 
And we need to acknowledge that this is a very personal and emotional topic for a lot of folks. There's a fear, anxiety, pride associated with assessing and using health plans effectively. So this is not an easy thing to change and this is going to be a long-term process and we have some roadblocks with health literacy and basic financial literacy along the way.

And with that in mind, we need to acknowledge that no one really knows what we're talking about as an industry. All of these terms are really easy and familiar for us but the invention of consumer driven healthcare (CDHC) created this whole new vocabulary and this is confusing and overwhelming and adding an additional layer of complexity to an already confusing and complex healthcare system.

As we're going through this, as you're working on consumer driven plans and your health care strategy, put yourself in the shoes of the average American who is completely overwhelmed by healthcare decisions and does not know anything about the healthcare industry. And is really intimidated by the cost implications of these plans.

The cost implications are absolutely very real. And we need to really understand this, particularly for low-income folks. So household finances and employee financial literacy play a big role in the success of high-deductible plans.

Everyone has very strong, emotional ties that have shaped their ideas about how they manage money and so forth. But just strictly from a numbers perspective, high-deductible plans are really hard on low-income workers. Even though the lower income workers are often the ones who are more likely to select the plans because of the lower premiums.

Let's look at some stats on that.

76% of Americans are living paycheck to paycheck. And that's the reality across the income spectrum that’s not just about low-income folks. But when we look at low earning families’ incomes, the amount of money that goes towards healthcare is really overwhelming.

The average high-deductible plan premium takes about 7% of the low earning families annual income. If they contribute the max to a health savings account (HSA), that number put towards healthcare jumps to 15% of their total income. 
26% of a low-earning family's income is needed to cover the average high-deductible plan out-of-pocket maximum. So that's an intimidating number for low-income folks and especially those that are just scraping by supporting their family.

Not surprisingly, over 50% of low-income workers experience problems paying medical bills or have medical debt. And this is just the reality that these plans are in. There's no doubt that these plans are the way forward but we need to approach them with empathy and understanding of the average workers' income scenario and how this really plays out.

This is such a great quote from EBRI. And this is why effective communication around consumer driven plans and high-deductible plans is more important than ever before. “There's strong evidence that workers simply lack the ability to successfully navigate the complex and technical nature of healthcare. And this is absolutely true for the financial services sector but what we need to remember is this is not because people don’t care. Or not because they don't want to understand, but because the system is flawed and in many ways is really stacked against the individual.”

This is no more obvious than in the discussion about high-deductible plans and healthcare. This is complex stuff that people really and fundamentally do not understand and don't currently have the skills to tackle.

Employees need you in this. This is why the role of an employer is so important and this is why we are so inspired about the work we do and why I am so passionate about employee communication.

Unbiased and trusted sources of health and financial information are so desperately needed in our country. And employers are one of the few trusted and reliable sources of that information.

Your employees need you more than ever before. They need you and they want you to help them navigate our systems and set them and their families up for success. And because they look to you as an employer, as a trusted source of that information, you can use effective communication to build trust and loyalty to your organization. Even in times of unprecedented change.

Let's talk about how we do that.

Right now there's a big, big disconnect in most organizations around what we're asking employees to do and what we provide to them to help them get there. We ask them to be a good healthcare consumer—whatever that means. We ask them to improve their health and wellness, to save for the retirement and to understand and appreciate dozens of complicated programs, but often what we're providing them is complicated plan designs, once a year education, confusing and overwhelming information, lots and lots of separate and disconnected resources, and many times, little access for their families.

We need to bridge these two. We have to start communicating and start creating systems that meet the needs of employees and help get the right resources in place for this huge behavior change we are really asking folks to do.

It will be no surprise to you all that we really see and believe—and we've seen over and over again that the key to success with consumer driven plans is to prioritize employees’ needs at every step of the way. Start with the planning in plan design, going through implementation and pre-enrollment, into enrollment and then year round support. And when you put employee needs first, every step along the way you will create tremendous success. You can create absolutely amazing results.

Let me share with you a little bit about one of our favorite case studies with Adobe. This case study is on our website. We've pushed it out on our email list a couple of times so you may have read about it already. But we helped Adobe launch an HSA plan last year and they got 62% of their employees to choose that plan without eliminating any options.

This is just a phenomenal case study in so many ways. But what's important for us is that they followed every single best practice about implementing, designing, and communicating a plan to the T, and that's what created that result. We helped them launch this gorgeous external benefits website that was the cornerstone of their campaign.

We had a super bold, creative, exciting campaign, lots of targeted communications, lots of creative and interactive communication and an education tool. All with the foundation of extensive focus groups that we did with their employees to understand how they understood the plans right now, what they reacted to with the new designs, and so forth.

Let's look what really made Adobe a success. And we'll talk through this in a lot of detail that go into the best practices:

• Their internal factors were unique.
• They had an HRA in place for many years so the HSA was really set up to transition folks from the HRA into that new plan.
• They had highly compensated and tech savvy employees so they have the right demographic to really understand and embrace the HSA, particularly for its retirement savings impact.
• And they have a very positive company culture right now with a very successful business.

But the benefit plan design and communication strategy factors are something that every organization can replicate. And that is:

• We did extensive focus groups to gather employee feedback.
• We helped them create a very simple plan design with simple plan names so that people could easily compare their choices.
• We did a very bold and creative campaign, not holding back at all on the creative messaging, on having an opinion and really sparking a conversation within their organization.
• And we did a lot of targeted and personalized messaging so folks could really see exactly how that change impacted them.

It’s easy to say, “Well, what made this a success was because they have highly compensated and tech savvy employees. That that's the type of people that gravitate towards this plan.” But that is not necessarily the case. It really is about looking at the whole spectrum on how you design and implement a plan. And we've seen when you skip one portion or when you don't have a bold and opinionated view in one area, you're not going to be as successful.

Another company that has a very similar demographic as Adobe, a similar employee focus culture with rich benefits. They had a very different result with their rollout. Instead of having a bold and aggressive approach to marketing the plan, they wanted to present a very neutral point of view across the medical plans. They didn't want to use decisive language to introduce the new plan or suggest and recommend why people would choose it and there was no strong education on the long-term value of the health savings account.

What we saw with this company was very low enrollment in that plan for two years in a row. So, regardless if you have the right employee demographics and you have the people who should be in this plan, they're not going to choose it if you're not really bold and aggressive in telling them how it works and pushing them in that direction. We were able to increase the enrollment to that 25% of the population that third year when we started to use a really bold marketing approach with this organization. But that's a long time frame to get to that level of enrollment with a population that is really right for it.

On the other side of things, when you have a population that is maybe a little bit more challenging to reach, you can still create good results with these plans by really investing in the plan design and communications strategy.

This is a case study from several years ago with a company that had a consumer driven health plan (CDHP) for several years with very low enrollment and wanted to increase that dramatically. This company was a very diverse employee population—large manufacturing population as well as corporate and sales. On the surface a more challenging population to engage in consumer driven plans and engage in healthcare overall.

With them,

• We revamped the design and all the communications.
• We created a strong tie to their wellness strategy and to their high deductible plan.
• Did a bold, creative campaign.
• Had a quasi-mandatory enrollment. By that, we created so much buzz about enrollment that is seemed like it was required even in a year that wasn't technically an active enrollment.
• And they modified the plan to make it more attractive: tweaking the HSA so that it funded up front, adding preventive drugs not subject to the deductible, and then making biweekly contributions more attractive.

Their results were that in that one year they were able to increase participation from about 20% of the population to over 55% of the population. We also completely eliminated the number people who were enrolling in the high deductible plan but not opening their health savings account (HSA), and significantly increased health risk assessment participation as well.

Even if you've had a plan in place for several years and you want to push it along or you want to move toward a full replacement, all of the strategies I'm going to talk through can work. You can revamp your plan and revamp your approach to communication if you have one in place or you can use all of this to launch a new plan.

Let's talk about what it means to really prioritize employee needs at every stage.

We start with planning and plan design. In this area—and hopefully if you're looking towards a fall enrollment—you are deep in this right now and this is an opportunity to look at the demographics of your population, to set goals, to focus on the simplicity of plan design, and of course to talk to employees

When we look at considering the demographics of your population, understand the salary levels, the age and family scenarios that are going on, the type of workforce you have, and the participation in saving vehicles that may exist right now like your 401(k) and your flexible spending account (FSA). What can you glean from that in terms of the way people are thinking about saving for retirement or how actively they are managing healthcare costs?

When you look at all of that and what’s really happening in your population, you can preempt some of the barriers to adoption with smart plan design and smart communication.

You need to set goals while you're in the planning and plan design and look at goals more holistically instead of just enrollment in the plan. As I said at the beginning, being a consumer of healthcare is much more than enrolling in a high deductible health plan. We really need to teach people a whole new language, a whole new set up behaviors for how they use the healthcare system. If you can, set goals that are beyond just participating in plans, and look at how people are using your resources holistically. Are they accessing online decision support tools, are they contributing to other plans that help them save, are they using your preventive care and wellness benefits and so forth? Those broader goals will help you see how you're making progress year over year rather than focusing just exclusively on the plan enrollment.

Simplicity of plan design is a huge factor in adoption of these plans. Keep it simple. The actuaries love to get super creative with the plan design on these but you want something that people can compare and they can understand. Our recommendation is whenever possible, keep the coinsurance and copays the same across plans. If you can, have your high deductible plan side-by-side with your PPO and the only thing that is different is the deductibles, health savings account (HSA) contributions, and out of pocket maximums, it’s going to be a lot easier for folks to understand how that plan's costs work and not be intimidated by the plan design. When you look at something and you try to compare, “oh the plan pays 80%, this plan pays 90%, this plan pays 70%, this one has a $20, this one has a $30 copay,” it’s immediately completely overwhelming to folks and when people are overwhelmed, they don't make a decision. And inertia and lack of decision is one of the biggest factors we need to overcome when we're getting people to adopt these plans.

There are lots of plan levers that you can use to drive enrollment. I would like to say proceed with caution on all of these and decide how aggressive you want to be.

One plan design lever is, of course, replacement, and that is something that many years ago that was very intimidating for companies to move toward. I think right now, moving towards full replacement is a lot let less intimidating for companies and in many ways can be a lot less confusing for employees. Obviously full replacement is the way you're going to drive enrollment in your high deductible plan.

You can take away a popular option and we do highly recommend this. If you are launching a plan for the first time and you have a large portion of your folks in a PPO or a more traditional plan, take that option away or rename it to force a decision. It’s much harder to get people to act when their current option remains.

Of course you can dramatically increase the price on that popular plan as well. And price the consumer driven plans much lower.

You can also make the consumer driven plans more attractive by including additional coverage or special programs. We see that out here in Silicon Valley quite a bit where the consumer driven plan will have additional benefits for fertility services or ABA therapy and so forth. And that is definitely a way to increase the attractiveness of that plan and give people another reason to enroll.

You can also force an enrollment decision every year and of course make the consumer driven plan the default plan for both active enrollment and new hires. That default plans communicates a lot, we know that from behavioral economics. If you really want folks in your consumer driven plan it absolutely should be the default plan for your new hires and it should be the default plan for anyone who doesn't actively enroll.

The other big component in planning plan design is focus groups. Just getting out there and talking to employees. We see so much resistance to doing focus groups but they are so incredibly valuable. They don't have to be complicated, they are much easier to orchestrate than you think. Whether you do them yourselves or you get some outside help to do them: just do it. Getting out there and talking to employees about this is the most important thing you can do to help your communication and your plan design. It will be absolutely enlightening.

I was listening in on focus groups early this week, and you just cannot replicate the value of that employee feedback. If you're going to do them yourself, get 6-8 employees per group, set up 30-45 minutes, ask a bunch of open ended questions about the plan, about how they use their benefits, where they access resources, and so forth. Encourage discussion among them. You will get such valuable feedback. If they won’t share with having someone from the benefits team in the room, get help from someone else in HR or from corporate communications so that you can encourage that really direct feedback. Give employees a place where they feel like they can be critical of your benefit plans and the way you're communicating.

Of course, offering a little of food never hurts to get people to attend the focus groups.

That's the planning of plan design component. Let's talk about implementation and pre-enrollment.

This is the time where we are really looking at how do you coordinate vendors? What is the total employee experience from enrollment to ongoing support? This is where you should be considering a benefits website if you don’t have one already. And you should be developing your detailed key messages.

When it comes to coordinating vendors and mapping that overall experience, think about and truly map out what employees are going to need to do to get through your plans and to use all of the different administrators you have in place. And choose vendors and providers that will coordinate and create a cohesive experience that gives your employees good resources and good tools.

This is a great place to think about whether you want to have a transparency tool or other decision support tools. And when it comes to choosing your HSA vendor, make sure you find one that will provide robust implementation, enrollment, and ongoing communications. There are great resources out there from several of the vendors and you don't have to feel locked in to using the HSA provider that your health plan partners with just because that's the way they have things set up. Really look at who's going to provide the most resources for your employees and the best experience for them.

One example of that is we've done a tremendous amount of work with UMB healthcare services. They're an HSA administrator and we've helped map out their entire implementation process. They have robust communication toolkits that they provide all of their customers. They also have invested in really deeply understanding the way people use their health savings accounts (HSAs) working that into the account holder in employee communication. That's a great example of a vendor who's really invested deeply in that engagement side of things and providing their customers great resources. Have high expectations of the vendors you are looking at.

This is also the time to really look at investing in a company benefits website if you don’t have one already. This is our number one recommendation for companies across industries. All large companies should have an external benefits website. Company benefits.com; that one-stop-shop for benefits information. It’s where you push employees to for all their needs and then you link out to all of the other carriers and providers. It’s simple, 24/7 access to employees and also family members. It’s an incredibly valuable resource for recruiting and new hires. This creates simplicity out of the a very complex ecosystem and all of the different vendors and providers who make up your benefit plans. If you don’t have this now, look at investing in this and it will be an absolutely, transformational foundation to launch your consumer driven plans as well as do the ongoing education that is so needed to make these plans a long-term success.

Implementation and pre-enrollment are also where you need to be developing your key messages. And hopefully these key messages are based on focus group feedback and talking to individual employees about what they need and how they understand your benefits.

What we see in messages around consumer driven plans—and unfortunately we still see a lot of this kind of crisis orientation—“healthcare costs are skyrocketing, the sky is falling, if we don't all change everything the company's not going to be able to afford healthcare going forward.” All of that might be true and you may very much feel that in your day-to-day, but that type of messaging is not going to get people excited about these plans. It’s not going to get them engaged in changing their healthcare behaviors.

Also, telling people to be better consumers of their health is not an engaging message either. People don't know what that means. It doesn't make sense. We have to break that down. What does work is a change orientation instead of a crisis orientation. Talking about personal stories, testimonials, how the plans work, helping people really understand what it means to them, doing the math for them and making things really simple. Then, of course, appealing to the emotional impact of becoming healthier rather than this scary reality of how much our healthcare system is changing.

In those messages you want to focus on employees and their families and their personal needs. It is really easy to take on a company focus when it comes to healthcare messaging and that's not engaging and it’s not going to help your employees understand these plans and it’s definitely not going to help them change their healthcare behavior.

• A company focus is something like: the company spends $60 million a year on healthcare benefits.
• A more people-focused message is: the company invests about $11,000 per employee in our benefit program.
• A company focus is something like: we need employees to be better consumers of healthcare in order to save money.
• A people focus: when you learn to use your healthcare benefits more effectively, you can save money and you can get better care.

When it comes to HSA messaging, there is a big spectrum of the way people can use these accounts. And this is where it gets very important to think about the demographics of your population.

A. Do you have lower earners who are going to need to use their HSA accounts like an FSA? And they're going to need that company contribution to the HSA to meet their deductible every year?
B. Or do you have higher earners who are maxing out their 401(k) contributions and looking for additional retirement savings vehicles?

We think of those 2 populations as “spenders” vs. “savers.”

Spenders are the ones who need to use their account and the employer contribution every year. The key messages to that population need to be about:

A. Ways to budget and save on out-of-pocket costs. 
B. How the company contributions work.
C. How you could direct your premiums savings to put more money in your HSA and save for a rainy day…
D. Not skimping out on preventive care because that's free. You want to really emphasize the access to the services that are free.

The “savers” are the folks that can afford to pay expenses directly and use their HSA for long-term saving. And that's really where the value of the HSA really comes in: as a long-term savings vehicle, the HSA really cannot be beat. But you don't want to promote that to employees where that’s not relevant to all. So for the folks that can afford to:

A. Really educate them on using their HSA as an additional retirement savings vehicle.
B. Maintain that tax shelter.
C. Building the healthcare nest egg.

Those can be really compelling messages and they can make the HSA and the overall switch to this type of system much, much more appealing especially for the folks that are looking for those additional tax savings.

After implementation and pre-enrollment, we get to annual enrollment. Many of you are looking towards a fall enrollment and when we look at enrollment we want to:

A. Plan for early communication, but not too early – we'll talk about that in a second.
B. We want to give detailed scenarios and clear messaging.
C. We want to consider targeted communications to really get as specific with messaging as we can and help make things really relevant to folks.

When it comes to enrollment, we want to communicate early of course, but not too early. If you start communicating too soon, you're going to create the impression that the change to the CDHP is a bigger deal than it actually is. And employees are going to want to compare details and get in the weeds if you get too far ahead of the message without all the tools in place for them to do that. You're going to lose momentum and create inertia in that process.

Communicate ahead of time but don't worry about these long timeframes of 6-9 months ahead that we use to plan for these types of plan changes. Definitely start with leaders and if you can get the leaders engaged and get them to really click and understand these plans. That's going to be a huge help.

We also really focus on engaging managers—you can see a manager tip sheet that’s on the screen. You don't want to put them in the position or ask managers to help explain the health plan details but:

A. They need to know that a change is coming.
B. They need to know about the communications.
C. They need to know how to point employees to the right resources to get their questions answered.

Enrollment, of course, we want to use as many channels for communication as possible. Really look in your organization at the traditional channels whether it’s guides or newsletters or postcards, employee meetings, tip sheets, and so forth. Also look at the online and interactive. Hopefully you have a benefits website, if not use your intranet. Email, social media, videos are so great for communicating HSAs and we've done really fun animated videos around HSAs and comparing the plans and so forth and gotten great feedback from employees about providing that resource.

Webinars are a great tool, a great way to disperse employee meetings in a cost-effective way. You might be looking at providing some decision support tools there.

The unexpected channels: things like infographics, ecards, podcasts, large format installations at your health fair, peer champions—truly anything you can dream up. Any of the creative channels you can use to get the word out; use them. Be creative. Make a bold splash with this campaign and you'll get people's attention and you'll create a positive experience.

In all of those channels, you want to show very detailed scenarios. Don’t gloss over the details, don't make employees do the math, and don't make them make them make any assumptions on how the plans work. Really spell it out. We do this in creating personas, showing how other people decide, lightweight decision support tools that walk through a series of questions: is the HSA right for you?

And those are some screenshots from a video that stacks up the HSA vs. an HRA and FSA. Really get into the details on those. Appreciate the level of complexity of these plans and how much you really need to spell it out to get people comfortable with them.

We also highly recommend targeting in your campaign. Look at sending out postcards or emails or a section of your newsletter that is targeted. You can do that based on someone's current plan, on whether or not they have family coverage, perhaps on their current 401(k) enrollment—to send a specific message to folks that are maxing out their 401(k) to tell them about the HSA. Targeting and segmenting your communication makes it so much more valuable. It doesn't add that much more additional cost for something that creates a much higher impact piece at the end.

Our next webinar series is actually all about targeting and segmentation. So if this is of interest to you, I encourage you to listen in to that. We'll show you all the details on how to do this in very low risk, easy to implement ways.

Also—across the board—and this is true of all benefit communication not just high deductible plans and not just open enrollment.

• Make it easy for employees to take action.
• Focus on using the benefits on that next step, that next behavior you want them to take.
• Have a call-to-action in the pieces.
• Make things relevant based on age, family situation, life stage.

As I just said, do the math and take it step-by-step.

After enrollment and after you launch a CDHP for the first time, you're going to be exhausted and you're going to want to kick back and take a little bit of a deep breath but that's precisely the wrong thing to do. You need to keep momentum going year round. And looking at the way that you support communication as well as use of the accounts in January and February and March is almost as important as the way you communicate during enrollment.

As soon as you're done with enrollment, look at how you're providing year round support. This is when you want to measure success, you want to plan ahead for ongoing education, you want to support people in opening and using their accounts, you want to use targeted communication to improve people's behavior and nudge them towards better decisions.

With year-round support, you want to measure your success and see how you did and then get a plan in place for ongoing communication. Where you can give people a lot of step-by-step guidance to build their confidence.

A. How do they open and use their HSA?
B. How do they process claims?
C. Where do they go with questions?
D. What happens when they get that big bill?

All of this is critical to getting people to change their behaviors and to stay in that plan the second year if they have the option to move out of it. So really invest in that type of year-round support.

There are great resources out there to help you with helping people understand how they can get better care and how they can start to change their behaviors with healthcare. So we were so happy to be part of the Choosing Wisely campaign.

Choosing Wisely is a national initiative to help people reduce unnecessary care in the healthcare system. Consumer Reports has rich resources out there to help people have good conversations with their doctors and to understand when to push back on tests and procedures. And NBCH and PBGH—we worked with them to create the Choosing Wisely employer toolkit. So out on NBCH's website you can go get that toolkit. It has dozens of articles and tip sheets that you can use for your communication and some of them – like the ones on screen—are ready to go. You can put them on your website, you can send them out to employees, and help them understand how active of a role they need to have in getting the best care and how much better their outcome can be when they do that.

Finally, I want to note that all of this is on the foundation of our overall approach to successful benefits communication. The webinar we did—this approach is detailed in our white paper but what you need to do is look at how you create access to benefits information by getting that information online and outside of your firewall and then keep talking—engage with employees and their families year round. And then work smart using the low-cost and free resources like:

• What your vendors provide
• The Choosing wisely toolkit and so forth

That's the foundation of what we believe makes benefits communication successful across the board. And launching a consumer driven plan is a great opportunity to invest in the infrastructure like a benefits website and start to create that ongoing dialogue if you're not already doing that in your organization.

Some final thoughts before we get to Q&A. We've covered a lot on how to make these plans a success. This is not easy. Consumer driven plans are not easy for you as the benefits team, they're not easy for employees, and their families, but this is absolutely the way forward. We know what's happening with healthcare reform, looking ahead to the excess tax. Everyone is moving towards high deductible health plans are the model of the future. This is absolutely the way forward but that does not mean that is going to be easy. It takes a lot of work. We absolutely need to invest in communication and most importantly, employees desperately need you to help them make good decisions in this new world. As an employer you can really own that opportunity and create an experience that is going to create loyalty to your company and really reinforce the value of benefits and that incredible amount of money you are spending on those benefit programs.

It takes investing in communications but you can make an absolutely huge impact in your communications by investing less than 1% of the cost of benefits themselves. Please use this format to make that investment, to give your employees the tools that they need and when we do that, we will be able to create good outcomes for our companies as well as our employees and their families in this very new and sometimes daunting world of healthcare.

Let's move now to some Q&A. We have a good amount of time left for Q&A and it looks like quite a few questions have come in.

Q. Where did you get your background on HSAs?
A. This is the work I have done my entire career. I worked for Hewitt Associates. Starting right out of college and did some very early work with consumer driven health care and consumer driven plans there. Did some of the earliest HRA implementation that goes back to 2002 and 2003. Some of the first HSA implementations that were in 2004 for the plan year 2005. Then, since starting Benz Communications in 2006, we've really been focus on this and we're very lucky to work with early adopters. We've worked with CDP in all different industries, lots of different sizes of employers, lots of different employee demographics as well as working with organizations like UMB Healthcare Services, which is a very sophisticated HSA administrator. Lots of background and experience and it’s kind of unbelievable how long these plans have been in place for how hard it still is in some organizations to get traction.

Q. One question about the plan design: What do you mean when you said you tweaked the HSA to fund up front?
A. That is a plan design possibility. You can pre-fund an HSA if an employer is contributing to the HSA. You can let all of that money be available to employees January 1, and that helps get over one of those barriers of you know “What if I get hit by a bus on January 1, I'm not going to have that HSA money available and I'm not going to be able to pay my deductible.”

Q. This was our first year to offer a high deductible health plan and we struggled with what to call it. What are some good name examples you have come across?
A. That is a great question and definitely do not call it the high deductible health plan; that is not an appealing name. Don't call it a catastrophic plan. We have had the most success with simple names like: the Health Savings Plan or the Health Savers Plan. Compared to the traditional plan or keeping a PPO structure in place. I think the plan names that reinforce savings and are simple are the best way to go.

Q. Another question on plan design: can you elaborate on the default plan?
A. This is another plan design nuance that's really important. When you set up your plans, often companies don't think to switch their default plan. If you have a PPO and an HMO in place now and perhaps the PPO is your default, when you introduce a consumer driven plan, make the consumer driven plan your default plan for new hires. If people don't enroll, they're automatically enrolled in that plan. You can be more aggressive with that and force an active enrollment and tell people that if they don't enroll, they will be automatically enrolled in that plan. It’s a bit more aggressive and not a lot of companies are comfortable with that but it sets the right message, which is: this is the ideal plan, this is the best value for our employees, and this plan has everyone covered.

Q. Here's a question from a company that's been full replacement HDHP with HSA for 8 years, they're moving to a state that taxes the HSA funding on a state level. How do you suggest making that transition and communicating that plan as still positive?
A. I'm in CA and CA is also a state that taxes the HSA at a state level. But that has not dissuaded employers here or employees from adopting those plans at a high rate. I would spell out some very clear examples of that and talk about the impact on the state taxes, but it’s really not going to be a significant amount of money. Perhaps even look at communicating how little that amount of money is compared to the overall federal tax savings that they have with the HSA. I don't think that that is going to be a huge negative or a huge takeaway from employees. It’s just not that significant of amount of money.

Q. How can you target communications electronically without running into HIPAA?
A. When we are targeting communications, we are generally not using personal health data. You can target communications based on plan enrollment or location, even 401(k) participation. That's not going to get into any personal health information. You can absolutely do some very sophisticated targeting and segmentation of communication without ever touching personal health information.

Q. Question about the stats in the beginning and we will follow up with all of the sources for our stats.
A. Those stats on low-income workers in the beginning of the presentation came from EBRI, UMB, Towers Watson, MBGH and the Common Wealth fund for some of the HSA stats. The low-income stats came from the Kaiser Family Foundation and the Commonwealth Fund.

Q. Do we have any resources to help sell to leadership the idea of building a benefits website. Love the idea but feel it would be a hard sell.
A. I'm happy to talk with your leadership anytime about the value of that website. We have a lot more detail on it in our first webinar series which is about our 3 steps to success, but a benefits website is absolutely the best investment you can make in your benefits communication. It’s an infrastructure investment that will pay for itself over several years. We have lots of great resources on that and the biggest thing with any investment in communications is a lot of companies look at communications as an additional line item that they should be trying to reduce as much as possible but the way we should be looking at communications is as a security insurance investment that the huge amount of money you are spending on all of your benefit plans is going to be worthwhile and that your employees are actually going to value. When you look at the cost of the benefits website compared to the total cost of healthcare, it’s nothing. When you look at it compared to what you're spending $0 on communications now, it feels like a big investment so sometimes we just need to change the frame.

Q. A couple really detailed questions about the average contribution amounts for smaller employers to HSAs. Can you seed an HSA for employees only below a certain income level?
A. I'll have to follow up on those with our friends from UMB who are the HSA plan design experts. I don’t want to misquote on those. But another plug for UMB, they are a great resource on all of these details around HSAs and you can actually be a lot more creative with the funding and the set up on them than you might assume but I will forward any of these really detailed HSA plan design questions on to UMB.

Q. If you offer a high deductible plan with HSA and a PPO, can you still have a healthcare FSA for employees in a PPO?
A. Yes, you absolutely can. You can also have a limited-use FSA for everybody.

Q. Having different premiums based on salary levels. How do you create generic communications without giving too much detail?
A. The premiums based on salary levels are tough. I would encourage you to send out different versions of communications to folks that those different salaries tiers if that's possible. There's also some ways that you can personalize pieces if you really want to help people model out specific scenarios. A lot of the communication around HSAs and healthcare in general does not need to get into the level of exactly what the premiums are. The majority of the communications you do can be very general on the way the plans work, what's being offered and so forth and then you can either do some targeting and segmentation to get that detail on the individual premium.

Q. What are the ways to differentiate the communications for corporate versus manufacturing populations?
A. If you have a manufacturing population, I would still encourage you to look at an external benefits website to reach that population at home or to reach their family members and then we do quite a bit of co-opting communications for both populations. Perhaps the corporate group gets an email and the manufacturing population you send a pdf to the managers for them to print and distribute. The corporate folks might have more on their intranet while the manufacturing folks have more in posters and flyers, or placemats that are available on site. You can also decide to only send print materials home to one population. So if you want to send print materials home to the manufacturing population you can do that. Tell the corporate folks to access it online. So there are some ways you can change the distribution method but not have to reinvent the wheel for each piece of communication.

Q. If an employer is looking to implement a high deductible plan with an HSA for the first time, what is your experience with how much time it takes to properly and effectively roll it out as it relates to everything we've discussed?
A. In an ideal world, an employer who is launching for the first time would make that decision in January or February and be able to have all of the spring to vet it with leadership, get the plan design in place, do focus groups and so forth and have a very comfy timeline over the summer and into the fall to start creating the communication. That would really be ideal. The reality is most companies make the decision to launch these right around this time of year and that kind of May-June timeframe and it is a bit of a scramble to get the vendors in place, get the communications going and so forth. That's not as cozy of a timeline but it’s certainly feasible and I think that having a few months lead time to do the communications is fine for most organizations depending on the complexity and how much you have to vet them internally and so forth.

Q. Are these methods of communication more or less effective in a union or collectively bargained environment?
A. All of these methods apply to union environments or any complex environment as well. The culture of an organization and the trust within that organization definitely plays a big role in employees’ perception of these plans and their acceptance of them and their trust in the messaging. That is something to think about in the union group. But with union, you know, everyone wants things clearly and simply defined. You can have great success with the union group by giving good communication. With unions, it’s even important to get the leaders on board and to use their own leaders as spokespeople for the plan and advocates for the plan. But with a little bit of different nuance and so forth you can make these very effective. Unions are also a population that really appreciate when you actually go out and talk to them. Doing focus groups and getting feedback, getting them on board, helping them feel like they are part of the decision can be even more effective.

Q. How do transparency tools fit in to this?
A. Transparency tools are fantastic. They have been kind of the missing link in consumer driven plans for a long time. But they also become another resource for you to coordinate and to make a cohesive experience out of. So when you're looking at how all of your vendors coordinate the tools that you're going to provide, think about how that transparency tool fits in; whether it’s an outside vendor or something that your health plan is offering. Then promote it to employees. One of the misperception of all benefit tools is we have this idea that if we build it, they will come; if you make the tool available, they will use it. That is not true for transparency and that is not true for decision support tools. If you want to use a tool like that and you think your employees will resonate with it, you need to promote it, promote it, promote it. Make sure it’s integrated in everything else you do. That you really put a lot of focus on it so that people will use it.

Well, that is the last question, and we will wrap things up just a couple minutes ahead of time. Thank you again for joining. As I mentioned again at the beginning, this is the third session in our benefit communication master class. The first two are available on our website to download and listen to right now. Our next webinar is Data Drives Decisions—all about segmenting and targeting benefit communication.

You will get a feedback questionnaire after the webinar. Please follow up with any questions and we appreciate you joining and look forward to having you on our next session. Thank you so much.