journalfront

Medical Care

Open Enrollment Woes & Healthcare Companies to the Rescue

2024-12-10

Open enrollment for healthcare often presents a complex and overwhelming landscape. However, there are innovative healthcare companies striving to make this process more manageable. Let's explore how they are doing it.

Empowering Healthcare Choices During Open Enrollment

Understanding the Challenges of Open Enrollment

During open-enrollment season, as Business Insider reports, Reddit users flood the platform's health insurance and personal finance forums daily. They seek guidance on choosing the best health-insurance plans. For instance, a recently unemployed married woman in Texas wondered whether to enroll with her husband's employer or stick to COBRA. Another married person needed advice on coverage during pregnancy in 2025. In California, employees navigated dental-plan options with costs ranging from $0 to nearly $440 annually. Open-enrollment season typically runs from October to December, with companies having their own periods. Employees must look back at past healthcare utilization and anticipate future events while dealing with changing insurance options and family situations. This process can be extremely confusing, as Dan Beck, president and chief product officer of SAP SuccessFactors, explains.

Employees are tasked with reflecting on whether they maximized their benefits in the past year based on healthcare system usage. Simultaneously, they need to anticipate health-related events such as having a child or major surgery. The complexity is further compounded by life changes like moving to a new state or employer or a company changing insurance providers. Keeping track of life events that could change coverage, including moving, having a baby, or adopting a child, is also crucial. There is a special enrollment period outside of open enrollment, but it has a limited time for making changes and retaining coverage.

Employer Initiatives to Simplify Enrollment

Increasingly, employers are encouraged by their employees and HR-benefits companies to share more digestible benefits information. Karen Frost, a senior vice president at Alight, a cloud-based employee-benefits vendor, told BI that employees need help during enrollment. Some employers are partnering with third-party companies to handle payroll and health benefits and build software with clear step-by-step prompts. This helps workers make confident healthcare elections.

For example, in Alight's 2024 annual survey of 2,500 employees in the US, UK, France, Germany, and the Netherlands, 63% felt confident about their most recent health-plan election. However, there are generational splits, with 70% of Gen Z and 72% of millennial workers wanting personalized support compared to just 46% of baby boomers. Despite the decline in paper-packet methods, the enrollment process remains overwhelming due to life changes.

Mobile Apps and Generative-AI in Open Enrollment

To assist employees during open enrollment, some healthcare startups are leveraging mobile apps and generative-AI chatbots. Alight aims to learn about employee preferences and family needs through Q&A and make recommendations. It provides clear definitions of complex benefits like health savings accounts. For instance, if an employee picks a high-deductible health plan, Alight guides them to an HSA and explains its benefits.

SAP SuccessFactors, with customers like McDonald's, L'Oréal, and Delta Air Lines, is focusing on developing its mobile app targeted at workers under 40 and frontline workers. It uses generative-AI chatbots to answer policy questions and improve the user experience. In the future, the company plans to automate some open-enrollment processes. To enhance its capabilities, SAP bought WalkMe earlier this year for $1.5 billion to provide real-time website navigation for healthcare and other tasks.AI-based virtual assistants are also gaining popularity. Alight has Ask Lisa, SAP SuccessFactors uses Joule, and Workday uses Wex. These tools allow employees to get automatically generated responses to their benefits questions. Workday's senior vice president, Ben Carter, emphasizes catering to all generations. AI-enabled tools like Workday Wellness integrate with insurance providers and help employers understand which wellness benefits are used and which ones need more investment.

"It brings a nice story," Carter said. "If I'm going to invest another $20 million in my benefits programs next year, I know where to go or where to double down."

Today, the American Nurses Association, the leading organization representing the interests of the nation's over 5 million registered nurses, is delighted to announce that Jennifer Mensik Kennedy, PhD, MBA, RN, NEA-BC, FAAN, has been recognized as one of Modern Healthcare's 100 Most Influential People in Healthcare for 2024. The comprehensive ranking can be found in the December 9 issue of MH magazine, and profiles of all the honorees are accessible online.

Celebrating Nurses' Impact in Healthcare Leadership

Recognition and Impact

This prestigious recognition program holds great significance as it acknowledges and honors individuals who are regarded by their peers and the senior editors of Modern Healthcare as the most influential figures in the industry in terms of leadership and impact. It showcases the important contributions of these men and women who have played a crucial role in shaping the healthcare industry in 2024. They come from various sectors of the industry, and their leadership has had a profound impact, ranging from the doctor's office to Capitol Hill.The list serves as a testament to the power and influence of these healthcare leaders, who continue to drive positive change and make a difference in patient care.

Dr. Jennifer Mensik Kennedy's Achievements

Dr. Mensik Kennedy is widely recognized for her outstanding work in helping the association achieve clinical, operational, and financial goals. She has also had a significant impact on the organization's work environment through initiatives such as workforce retention and employee development programs. Her leadership extends beyond the local level, as she is a leading voice in the industry, affecting change at both the national and local levels through her advocacy for nurses and patient care.Her tenacity in advocating for nurses and her commitment to fostering an inclusive workplace culture of diversity, equity, inclusion, and innovation are truly inspiring. Under her leadership, the American Nurses Association has added several thousand new members, launched new initiatives like the Advance Nursing Fund, and bestowed more than $300,000 worth of grants to further antiracism initiatives within various associations and organizations.

Leadership and Future Vision

Dr. Jennifer Mensik Kennedy will commence her second term as the 38th president of the ANA on January 1, 2025. She has held numerous leadership positions within the ANA for over a decade, and her clinical experience as a direct care nurse on the frontlines spans over 25 years.Her passion for the profession and her unwavering dedication have helped shape the collective vision for the future of the organization. She is a distinguished and fearless leader who continues to inspire others with her leadership and commitment to advancing nursing and healthcare for all.About American Nurses AssociationThe American Nurses Association is the sole association that represents and serves as the professional home for all registered nurses in every specialty and practice setting. We firmly believe that nurses are the lifeblood of healthcare. It is our mission to advocate for nurses and the causes they care about by working towards improved work environments, top-quality education, more intelligent policies, and stronger partnerships. We strive to amplify nurses' roles, their voices, and their value across healthcare and in society.About American Nurses EnterpriseAmerican Nurses Enterprise brings together the expertise and dedication of the American Nurses Association, American Nurses Credentialing Center, and American Nurses Foundation to champion nurses, advance standards of excellence, and inspire transformative change. With a rich legacy and a forward-thinking vision, our influence reaches federal and local levels through state affiliates and partners, amplifying the voice of nurses across all practices and specialties. Every day, we utilize The Power of Nurses to increase the value of the nursing profession and transform the healthcare experience for all.About Modern HealthcareModern Healthcare is the most trusted business news and information brand in the healthcare industry. It empowers healthcare leaders and influencers to make timely and informed business decisions. To learn more or subscribe, visit www.modernhealthcare.com/subscriptions.

Young adult immigrants known as "Dreamers" in 19 U.S. states face a significant setback as a federal judge's ruling temporarily blocks them from obtaining health insurance through the Affordable Care Act's public marketplace. This decision, issued by Judge Daniel Traynor from Bismarck, North Dakota, has far-reaching consequences for these immigrants and the Biden administration's efforts to provide them with essential healthcare.

Judge's Ruling Puts "Dreamers" at Risk of Healthcare Disruption

Background and Context

The Affordable Care Act aimed to provide healthcare access to a wide range of individuals, including immigrants brought to the country illegally as children. However, Judge Traynor's ruling, based on concerns raised by Republican attorneys general in 19 states, has now limited this opportunity. This ruling comes at a time when the Biden administration was working to expand healthcare coverage for these "Dreamers." The lawsuit filed over the policy will remain in effect until a trial can be held, leaving many "Dreamers" in a state of uncertainty. 1: The significance of this ruling cannot be overstated. "Dreamers" have been waiting for years to access life-sustaining health coverage through the ACA. Now, with this temporary block in place, their healthcare options are severely restricted. It raises questions about the fairness and accessibility of healthcare for this vulnerable population. 2: The GOP state officials' arguments against the rule are centered around the fear of immigrants potentially qualifying for public subsidies and the potential cost to states. They believe that the rule creates a strong incentive for immigrants to remain in the country illegally. However, this perspective fails to consider the human aspect and the need for healthcare for these individuals.

Legal Implications

Federal law gives the Centers for Medicare and Medicaid Services (CMS) the authority to determine legal status, but Judge Traynor emphasized that it does not allow the agency to redefine "lawfully present." This legal distinction is crucial as it determines who is eligible for certain benefits. The CMS's statement that it is reviewing the lawsuit but not commenting on litigation adds to the uncertainty surrounding the issue. 1: The legal battle between the Biden administration and the states highlights the complex nature of immigration and healthcare policies. It raises questions about the balance between providing healthcare to those in need and adhering to legal and financial constraints. 2: The outcome of this lawsuit will have implications not only for "Dreamers" but also for future healthcare policies and the relationship between the federal government and the states. It serves as a reminder of the ongoing challenges in addressing these issues.

Impact on "Dreamers" and Their Advocates

Nicholas Espíritu, deputy legal director of the National Immigration Law Center, expressed disappointment and frustration with the ruling. "Dreamers" have been waiting for more than a decade for this healthcare coverage, and now it is being taken away. His group will continue to fight the issue, highlighting the importance of healthcare for these individuals. 1: The "Dreamers" have faced numerous challenges throughout their lives, and access to healthcare is a crucial aspect of their well-being. This ruling further compounds their difficulties and leaves them in a vulnerable position. 2: Advocates for "Dreamers" will need to work tirelessly to ensure that their rights are protected and that they have access to the healthcare they deserve. The fight for their cause is far from over.

Reactions from State Attorneys General

Kansas Attorney General Kris Kobach called the decision a victory for the rule of law, emphasizing the need to adhere to legal definitions. Alabama Attorney General Steve Marshall also praised the court's decision, seeing it as a setback to the Biden administration's agenda. North Dakota Attorney General Drew Wrigley added that American taxpayers should have a say in how the federal government treats immigrants living illegally. 1: The varying reactions from state attorneys general reflect the political divide on this issue. Each side has its own set of priorities and concerns, making it difficult to find a common ground. 2: These reactions also highlight the importance of public discourse and the need for a comprehensive understanding of the issues at hand. It is essential to consider the perspectives of all stakeholders.