PPACA: Pandemonium Today, Panic Later, Prosperity for HRO

By Amy L. Gurchensky, HRO Research Analyst, NelsonHall

It was pandemonium after the United States Supreme Court announced its ruling upholding the Patient Protection and Affordable Care Act (PPACA). The outstanding decision left so many in a holding pattern pending the constitutionality of the act.

Now that the decision is more firmly settled for the time being (primarily pending the November presidential election), U.S. states and organizations will have to take more definitive steps in securing exchanges and evaluating whether to offer health insurance plans or pay the tax penalty.

In fact, the state of Florida, via Florida Health Choices, set the wheels in motion earlier this week ahead of the ruling when it awarded a $68m contract to Xerox to administer a health insurance exchange for nine years. Services include:

• A web portal and online plan selection tool
• Eligibility determination and enrollment management services
• Customer contact center services.

Other states that have delayed taking action are still expected to meet the law’s timelines. The same is true for employers that have yet to make employee healthcare decisions that take the PPACA requirements into consideration. Watch for a spate of webinars by benefits service providers to remind all of us of the changes still to come in 2014 through 2018.

Regardless of today’s decision, HRO and particularly benefits administration service providers have been sitting in a sweet spot.  Vendor interviews for NelsonHall’s recently published “Targeting Benefits Administration” market analysis revealed that business has been going on as usual with many employers turning to benefits administration vendors to implement services that are focused on controlling the cost of rising health care such as:

• Dependent eligibility audits to remove ineligible dependents from plans
• Wellness programs
• Improving absence management
• Switching to high-deductible health plans with associated health savings accounts.

The published report explores the current state of benefits administration as well as the future market and its growth over the next five years by geography and service line including:

• H&W administration
• Reimbursement administration
• Leave of absence administration
• COBRA administration
• Flexible benefits administration
• DC administration
• DB administration.

The analysis also looks beyond legislative implications in the U.S. and new offerings that have emerged such as health insurance exchanges to explore the automatic enrollment requirement in the U.K.

The greater unresolved issue at hand, however, is how to control the rising cost of health care that is already arguably unsustainable as evidenced by the more than 30m Americans currently without insurance.

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Benefits Administration Poised for a Good Year: Part 2

Earlier this week, I highlighted revenue growth reported by benefits administration service providers. In addition to the positive earnings reported, there are other signs indicating that 2012 will be good to benefits administration including acquisitions, hiring, and surveys.

There have been a few strategic acquisitions that will boost benefits administration revenues for vendors this year. For example, ADP’s benefits administration business will see a nice increase from SHPS, which had annualized revenues of ~$80m. Morneau Shepell’s acquisition of SBC Systems Company will modestly increase its revenues, and more importantly will strengthen the company’s presence in the U.S. Finally and most recently announced is Towers Watson’s acquisition of Extend Health, which will enhance its benefits administration offering by adding exchange services for retirees.

Another positive sign of expected future growth is the hiring of personnel. Towers Watson announced that it will be hiring employees within all of its segments. The benefits segment, specifically, will get an additional 172 employees, 60 of which will be for technology & administration solutions (TAS).

Finally, regardless of the constitutionality of the PPACA, benefits administration will likely flourish as compliance becomes increasingly complex as new regulations are issued or as older ones are amended for other federal laws such as COBRA, HIPAA, FMLA, etc.

A recent study by ADP cites that health care reform and compliance complexity are expected to lead to more benefits administration outsourcing. The survey, which included input from 504 HR and benefits decision makers in the U.S., found that ensuring compliance is one of the top reasons cited for outsourcing benefits administration.

In a recent article, Mercer is also advising employers to act to ensure compliance and to implement cost-control strategies now regardless of health care reform. It recommends the following, which are all dollar signs for benefits administration service providers:

• Managing the cost of dependent coverage, which will strengthen demand for dependent eligibility audits and verifications
• Shifting to CDHPs, which will lead to an increase for reimbursement account administration services including FSAs, HSAs, and HRAs
• Offering cost-competitive health coverage, which will boost demand for private health care exchanges for both active and retired employees
• Encouraging a healthier workforce, which will lead to the implementation of wellness programs (i.e., health assessments, biometric screenings, etc.).

Benefits administration is one of the oldest foundations of HR business process outsourcing and it is also one of the largest segments in revenues and yet it remains vital, adaptive, competitive, and ready for continued growth!

Amy L. Gurchensky, Research Analyst, HRO, NelsonHall

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Providing Value Through HRO Research

HRO service providers can derive significant value from producing and sharing research information. Vendors can show thought leadership, establish service and subject matter creditability, and reinforce brand differentiation, even as they gain a source of marketing materials and a lead-in to client discussions, as well as some free public relations coverage.

Much HRO research is designed to directly reinforce the need for the services and consulting offered by the service provider. A recent article by Ceridian discusses whether U.S. employers will drop employee health care plans when the Patient Protection and Affordable Care Act (PPACA) coverage requirements become effective in 2013. After providing some PPACA information, Ceridian moves to support services it offers, specifically consumer driven-health plans and health saving accounts.

When providers are not conducting primary research, it is important to reference other reputable resources. In this case, Ceridian quotes America’s Health Insurance Plans (AHIP), which recently reported that enrollment in Health Savings Accounts (HSAs) had reached 11.4m people in January 2011, a more than 14% increase over 2010. According to the AHIP, HSA enrollments have nearly doubled in the last three years and large group coverage was up 26% last year. Ceridian also quoted its executives, one of its own statistics, and ended with links to its web pages on CDHCs.

This is a solid, but perhaps overly focused on service offerings and marketing, communication designed to help it further tap a market where only 11m of a potential 160m are currently enrolled in an HSA.

A second example comes from a Mercer press release about the impact of automatic enrollment on defined contribution savings rates. It also directly supports Mercer services and it additionally offers information that is a bit more consultative.

Mercer used its own database of its 1.2m DC plan participants to show the positive impact of automatic enrollment and automatic increases on contribution rates. Participants who were automatically enrolled in their plan and use the automatic contribution increase have a 25% higher contribution rate (4.4%) than those who do not use the feature (3.5%).  Even better savings rate results come from self-enrolled participants (7.4%), and those who do self-directed increases, had the highest rate of all (8.5%). Company executives are used to further the messaging by commenting that those who self-enroll and set their own contribution rate contribute nearly two and half times more than those who are automatically enrolled.

With a bit more subtle communication, Mercer is establishing that it is a major player in DC by sharing information on what its 1.2m participants are actually doing that can help employers make policy decisions, support additional consulting, and reinforce the need to keep up proactive employee communications programs (which is a brand differentiator for Mercer) to support maximum effectiveness of the offered benefits of a DC plan.

Do you look at your vendor as a trusted and value-added source of information?

Linda Merritt, Research Analyst, HRO, NelsonHall