Worcester Business Journal

10 Worcester Business Journal • July 20, 2015 www.wbjournal.com Staples has 17 of these groups nation- wide, and each serves as a sounding board for the company's advertising and outreach campaigns to ensure they're responsive to the sentiments of a partic- ular community. They also have direct access to upper management to ensure the company's brand represents each group. These groups also organize speakers or events to boost awareness of issues throughout the company, Hopkins said. Meanwhile, The TJX Cos. has five employee resource groups that help with networking and career development. They sponsor educational, volunteer and social events and are open to anyone in the company. One of those groups is a resource for the LGBT community and others who support it, spokeswoman Colleen Beauregard said. "We aim to provide associates with tools to successfully navigate our diverse organization – whether that is training in how to work cross-culturally, provid- ing development opportunities or just helping associates to build a personal network," she said. The results of how a company treats its employees extend beyond improving employee productivity, coming into play when an LGBT person buys something locally, according to John Trobough, president of the LGBT advocacy group Worcester Pride. Whether through word of mouth or organizations like the Human Rights Campaign, which rates companies on their LGBT policies, word gets around on a company's attitude. For example, Worcester Pride would not support a restaurant that fires gay employees or doesn't treat them well. But some businesses boost their brands outside the office. TJX and Staples, for instance, have sponsored LGBT-related events and groups. LGBT inclusion and the law The Worcester-based law firm Bowditch & Dewey recently launched a blog devoted to LGBT issues, many of which are unique to lesbian, gay, trans- gender and bisexual citizens, from how to establish wills and trusts to same-sex divorce. Many of the posts are built off recent legal rulings or societal develop- ments, such as the transition of Olympic decathlete Bruce Jenner to becoming a woman. (He changed his name to Caitlyn.) "There are a lot of legal issues that are specific to (the LGBT) commu- nity that people don't realize are issues, and that community is a very loyal com- munity," Jennifer Garner, an associate at Bowditch & Dewey said. "Massachusetts has been at the cutting edge… it tends to be a very accepting place to live." This kind of outreach by the law firm Central Mass. businesses reach out to LGBT community >> Continued from Page 1 Authority, says there's nothing the state can do at this point to appeal for a change to the landmark health care reform law. With payers now filing for 2016, "there's nothing we can confi- dently state as an alternative at this point," he said. Since at least 2013, business organiza- tions and Massachusetts officials have asked the Obama administration to approve its state-specific methodology to assess insurance risk and predict costs rather than adopt the more-general ACA guidelines that cover all states. The risk assessment model is meant to level the cost of providing health care to high- risk or newly-insured, high utilizers of care. Plans with lower-risk insureds must pay into the pool, while those that carry higher-risk patients receive pay- ments. In Massachusetts, this skews the payment pattern in favor of larger plans with higher numbers of insureds and, therefore, more high-cost patients. Massachusetts, which uses 11 risk- rating factors that, together, make finer distinctions than do the four ACA fac- tors, has had nearly-universal insurance coverage since 2006, covering 96 percent of the state's population. The state is also unique in that it has merged its individ- ual and small-group markets to provide a break on premiums to individual sub- scribers. That, advocates argue, means more state-specific data are needed. Business groups add weight In May, the Massachusetts business community weighed in. The Associated Industries of Massachusetts (AIM), the Small Business Service Bureau, the Massachusetts Association of Health Plans, the Massachusetts Association of Health Underwriters, the Retailers Association of Massachusetts, six cham- bers of commerce, and Health Services Administrators, a benefits marketplace for small businesses, individuals and chambers of commerce in New England, teamed up to write to Sylvia Matthews Burwell, secretary of Health and Human Services. They advocated for Massachusetts' unique status as the first to implement a state-based health reform law that has already insured most of its residents — and to call attention to the formation of the merged market. But no dice. The Patrick administra- tion had received a three-year extension, during which the state could transition from its own rating factors to the ACA's, and last month, the Baker administra- tion successfully extended that by a year, giving Massachusetts until Jan. 1, 2018 to become fully ACA-compliant. Then, on June 30, the first bill came. The Health Connector issued final risk- adjustment results to the 16 health insurance carriers that serve Massachusetts' merged market. Flatter playing field? Meanwhile, Health Care for All (HCFA), a consumer-oriented health advocacy group, thinks the ACA's risk- assessment structure will be effective to "level the playing field" between plans with higher risk patients and those with- out. Suzanne Curry, senior health policy manager for HCFA, said it should serve to decrease costs for patients who need services the most. However, she said HCFA cannot address how health plans will react to the imposition of risk assess- ments. "We can't address individual plans, but we think the system is fair," she said, adding, "the implementation is critical." The ACA requires all applicants in the same age group to pay the same premi- um rate, and it caps premiums for the oldest age bracket at three times the rate of the premium for the youngest age bracket. Insurers, however, have no con- trol over the number of enrollees who sign up. Already this year, Fallon announced it will discontinue a program offered to disabled people age 21 to 64 due to eco- nomic unsustainability. That program largely does not affect the small-business community. But the fact that it attracted only 5,400 members, far below the 8,000 to 10,000 that had been anticipated, shows the make-or-break nature of enrollment numbers for smaller plans. Additionally, new drugs, while highly effective, are also expensive, which increases costs for insurers. One notable example is Sovaldi, a Hepatitis C treat- ment manufactured by Gilead Sciences Inc., which costs $1,000 per pill, or $84,000 for a 12-week course. Fallon: Risk assessment a disincentive David Przesiek, chief sales officer for Fallon, says the ACA risk assess- ment serves as a disincentive for insur- ers to offer health and wellness pro- grams, which have been a primary focus for Fallon since its inception in 1977. The plan has passed its savings back to individuals and small-business owners, he noted. "It's not sitting in our savings account." In a recent opinion piece in the Boston Business Journal, Fallon President and CEO Patrick Hughes and his counterpart at Health New England, Maura McCaffrey, wrote that the imposition of the ACA risk adjust- ment on Massachusetts "grossly under- values the cost of caring for healthy people and overestimates the cost of managing sick members… ." They warned that the result could be the termination of lower-cost insurance plans designed to attract healthier people and small business — "the peo- ple health plans would now be penal- ized financially for having." Przesiek noted that the costs have to be passed on to the small-business owner and could result in fewer choic- es when plans are discontinued. "If there's a theme here, there's choice. [The ACA] was not meant to limit competition. In Massachusetts, it's a law meant to solve a problem that did not exist in this commonwealth," Przesiek says, noting that there are safeguards in the insurance system such as reinsurance (a stop-loss finan- cial instrument), and risk corridors, which track utilization by high-cost patients, shielding insurers from unex- pectedly high costs. Fallon has submitted its rate request information to the state for 2016 and expects to hear back by Labor Day. "We are committed to small business and individuals. We will do all we can to come through on that," Przesiek said. n Health insurers, business battle feds over risk-rating factors Risk adjustments The results of the state's first risk adjustment process, issued June 30. Source: Commonwealth Health Insurance Connector Authority >> Continued on next page PAYMENTS DUE TO INSURERS Blue Cross Blue Shield HMO Blue .............................................................. $49,839,020 Tufts Associated HMO ................................................................................... $6,826,667 Blue Cross Blue Shield.................................................................................. $1,836,923 Tufts Insurance Co. ....................................................................................... $1,623,818 Fallon Health .................................................................................................. $850,658 Harvard Pilgrim .............................................................................................. $480,259 PAYMENTS DUE FROM INSURERS Neighborhood Health Plan ........................................................................ $27,646,254 Fallon Health .............................................................................................. $11,861,230 Boston Medical Center HealthNet Plan ...................................................... $5,149,610 Harvard Pilgrim ........................................................................................... $4,055,614 Network Health ............................................................................................ $3,690,452 Minuteman Health ....................................................................................... $3,064,679 Health New England .................................................................................... $2,630,068 United Healthcare ........................................................................................ $1,635,227 ConnectiCare Massachusetts ....................................................................... $1,243,072 Celticare .......................................................................................................... $481,138 >> Continued from Page 1

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