Pub. 15 2016-2017 Issue 3

N E W J E R S E Y C O A L I T I O N O F A U T O M O T I V E R E T A I L E R S 25 new jersey auto retailer W W W . N J C A R . O R G just a few years ago, that most employers would rely on technol- ogy as a means to help control costs. This generally meant a private exchange model that would allow for an increase in lower-cost plan offerings. The reality is that private exchanges in the small andmiddle market had no impact on plan pricing, and the carriers themselves allowed for a greater number of options even without a technology platform. This was further slowed by the increased acceptance of HDHPs as an option for all employees, not just the healthy or lower wage earners. Insurance companies also undertook several new strategies to control costs,with the goal of loweringpremiums and increasingmarket share. 2016 marked a significant increase in the availability of both Level Funded ASO programs and “narrow” networks. Level Funded ASO programs are self-insured programs that act much like a traditional fully-insured program. The three components of self-insurance – ad- ministration costs, stop-loss insurance fees, and claims are blended together to develop a fully-insured equivalent rate. All employees are billed like rates, and if claims run better than projected, employers may receive a surplus check. If claims run poorly, the employer can walk away without penalty. Both Aetna and Oxford, in New Jersey, entered this market directly for the first time in 2016. Perhaps the most significant change seen in the marketplace from carriers in 2016 is the expansion of “narrow” network products. A narrownetwork is generally a subset network, whose utilization often results in reducedout-of-pocket expense for anemployee accessing that network. Horizon’s Omnia program has seen significant adoption, with premiums often 5-10% lower than their comparable traditional A look forward to 2017 would be incomplete without mentioning the change in presidential parties. President-elect Trump led with the repeal of the ACA as a cornerstone of his campaign. In fact, many in the Republican party point to voters’ disenchantment with Obamacare as the primary reason for their winning the presidency. products. Employees accessing the Omnia subset network can see out-of-pocket costs reduced by as much as 40-50%. Amerihealth and Qualcare also have versions of narrow network products, and both have seen success as a result. Looking forward to 2017, there are several strategies that will likely see greater adoption rates. On the employer side, CDHPs will continue to grow and replace traditional plan designs. Wellness programs will continue to evolve and move down market to smaller employers hoping for healthier employees and increased productiv- ity. Employers are also expected to further embrace level funding and self-insurance. In 2017, a growing number of insurance carriers and employers will embrace narrow network programs. Horizon is expected to lead the way, as others play catch-up. Aetna rolled out a narrow network solution in late 2016, using the Meridian Health System in Monmouth and Ocean counties. Look for others to expand in this area as well. A look forward to 2017 would be incomplete without mentioning the change in presidential parties. President-elect Trump led with the repeal of the ACA as a cornerstone of his campaign. In fact, many in theRepublicanpartypoint tovoters’ disenchantmentwithObamacare as the primary reason for their winning the presidency.While repeal plays well in the rhetoric, it does not come without great challenges. For example,what happens to themillions enrolled through theACA? THE STATE OF HEALTH  continued on page 26