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An interview with Jimmy Lee of Anthem – Part 2

Hamoon Hadavand

Hamoon Hadavand

Senior National Account Executive at Softheon
Hamoon has more than 10 years of experience working with healthcare payers, strengthening existing client relationships and identifying new market opportunities across the country. He joined Softheon in 2012, after working as a Director of Business Development at America’s Health Insurance Plans (AHIP). Hamoon is passionate about working with payers to learn their business challenges and finding innovative technologies to enhance their operational efficiencies. He can be reached by phone at (202) 615-9222 or email hhadavand@softheon.com.
Hamoon Hadavand

Jimmy LeeAs of January 2017, approximately 27,000 employers have active coverage through SHOP Marketplaces, covering nearly 230,000 individuals. These numbers fall significantly short of the Congressional Budget Office (CBO) estimate that 4 million people nationwide would enroll in coverage through the SHOP Marketplaces by 2017. According to a survey conducted by Mercer, many small employers are considering higher deductibles and correspondingly lower premiums.

In part two of this two-part interview, Anthem’s former President of Consumer Division and SVP of Commercial Segments, Jimmy Lee, offers his perspective on the small group market, and approaches health plans can adopt in order to better serve their small group lines of business.

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An interview with Jimmy Lee of Anthem – Part 1

Hamoon Hadavand

Hamoon Hadavand

Senior National Account Executive at Softheon
Hamoon has more than 10 years of experience working with healthcare payers, strengthening existing client relationships and identifying new market opportunities across the country. He joined Softheon in 2012, after working as a Director of Business Development at America’s Health Insurance Plans (AHIP). Hamoon is passionate about working with payers to learn their business challenges and finding innovative technologies to enhance their operational efficiencies. He can be reached by phone at (202) 615-9222 or email hhadavand@softheon.com.
Hamoon Hadavand

Jimmy Lee

As of January 2017, approximately 27,000 employers have active coverage through SHOP Marketplaces, covering nearly 230,000 individuals. These numbers fall significantly short of the Congressional Budget Office (CBO) estimate that 4 million people nationwide would enroll in coverage through the SHOP Marketplaces by 2017. According to a survey conducted by Mercer, many small employers are considering higher deductibles and correspondingly lower premiums.

In part one of this two-part interview, Anthem’s former President of Consumer Division and SVP of Commercial Segments, Jimmy Lee, offers his perspective on the small group market, and approaches health plans can adopt in order to better serve their small group lines of business.

SFTN: With FF-SHOP having shut down on 1/1/18 and the uncertainty in ACA, how will this impact the small group segment for health plans?

JL: According to Mercer’s survey, many small employers are considering higher deductibles and corresponding lower premiums. This cost shift to employees often comes through the form of health savings accounts (HSAs) to help employees pay medical expenses. The combination of a high deductible plan and a HSA is a consumer-driven health plan – it puts more accountability on the employee as to where and how health dollars are spent. Survey results show that 10% of employees in companies with between 10 and 50 workers will purchase consumer-driven health plans, while 20% and 37% will purchase these plans in the 50 to 199 employees and 200 to 499 employee segments, respectively. The number of small employers that are self-funded is 15%; much less than the 79% at large companies. However, this number is growing in small groups, with product offering level funded options down to 10 lives.

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What’s new for SHOP in 2018

Yvonne Villante
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Yvonne Villante

Director of Marketing at Softheon
Yvonne Villante is the Director of Marketing at Softheon. Before this, Yvonne held several roles within the organization including Senior Research Manager, Corporate Research Manager, and Marketing Research Analyst. She holds a MBA in healthcare administration from Ohio University and a BS in business management from SUNY Stony Brook. During her undergraduate studies, she graduated within the top 10% of her class.
Yvonne Villante
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The Small Business Health Options Program (SHOP) will remain open for small businesses with 1-50 employees in 2018, and will boast new features that’ll impact how small employers and their employees enroll in and manage their coverage for SHOP plans starting on or after January 1, 2018.

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A Guide to the 2017 SHOP Guaranteed Availability Window

Sean Kirschner

Sean is a Business Analyst at Softheon. His objective is to provide insight into the current state of the healthcare landscape through research on both business and policy. He is also responsible for assisting the research team through creating and maintaining research briefings on various industry topics. He earned his bachelor’s degree in economics from Boston College.

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While small businesses can enroll in the Small Business Health Options Program (SHOP) at any time, today kicks off a month-long guaranteed availability window that allows small businesses to enroll in SHOP plans without meeting the usual requirements.

Starting today, the Federally facilitated SHOP (FF-SHOP) on HealthCare.gov is closed. Small businesses in FF-SHOP states will not be able to enroll online (though they will still be able to check their eligibility online). From now on, these small businesses will have to use a broker or agent to enroll in SHOP, or, alternatively, they can enroll directly with a health plan.

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Despite Challenges and Inefficiencies, SHOP Empowers Businesses to Obtain Coverage

Sean Kirschner

Sean is a Business Analyst at Softheon. His objective is to provide insight into the current state of the healthcare landscape through research on both business and policy. He is also responsible for assisting the research team through creating and maintaining research briefings on various industry topics. He earned his bachelor’s degree in economics from Boston College.

Latest posts by Sean Kirschner (see all)

In accordance with its goal of reducing the country’s uninsured rate, The Affordable Care Act (ACA) established the Small Business Health Options Program (SHOP) to create a small business insurance marketplace. SHOP’s purpose was to provide small businesses with unprecedented access to health insurance coverage for their employees, which was traditionally difficult due to their limited size. By setting up an exchange specifically for small businesses separate from the group and individual markets, SHOP tried to reach out and empower businesses that did not have the means to obtain coverage previously.  

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