1. "A journey of a thousand miles begins with a single step" -- Confucius
Based on the 5-4 ruling of the Supreme Court upholding the Individual Mandate, our country took the next step
toward implementing the Patient Protection and Affordable Care Act (PPACA). The only section of the
legislation ruled unconstitutional is the enforcement of Medicaid expansion which was designed to give the federal
government the ability to withhold Medicaid funding from states for noncompliance.
The Patient Protection and Affordable Care Act is intended to provide insurance to over 30 million uninsured or
underinsured individuals and ultimately help employers control one of their largest expenses by bending the cost
curve. The later goal being anxiously awaited.
Although it may seem like we traveled a thousand miles already with PPACA, the majority of changes take place
in 2014. The law could still be impacted by near term elections but as it stands now, the current implementation
timeline stands. Click here for the implementation timeline.
We look forward to assisting our clients with interpretation, communication and implementation of the law. Of
particular interest, we look forward to sharing the many innovations about to hit the market as we journey into the
new Healthcare Frontier.
This month's newsletter follows our new format sharing information in the following key categories:
 Know Your Employee Benefits- Tips to become a better consumer of healthcare
 Financial- Analytics, Trend, Surveys and Strategies
 Legal- Compliance, Legislative Updates and Impacts
 Human Resource- Benefit Trends: State and Federal Mandates
 Worksite Wellness Initiatives- Trends in Employer Health Initiatives
 Industry Spotlights- News Impacting a Specific Industry
 Horton Workshops- Notice of Train the Trainer Seminars and Webinars
Health and Prosperity,
Mike
Our Mission: To Help Our Clients Drive Down Cost, Employer Workload and Anxiety
__________________________________________________________________________________________
ph: (708) 845-3126 • mike.wojcik@thehortongroup.com

2. Know Your Employee Benefits
Medical Care Choices- Tips for Managing Your Health Care Expenses
A great newsletter to share with your employees to describe the impact they can have on your plan.
Some excerpts include: The role you play in managing health care costs is simple: Spend your health care
dollars wisely. Each time you go to a medical provider or receive medical services you generate a claim that must
be paid for through your employee health benefits. Essentially, the costs of your claims, and all your coworkers'
claims, determine the price you and your employer pay for your health benefits. In the end, decisions you make
directly affect the year-to-year increases in your health benefits cost.
Other topics include: Making Wise Choices, Office Visits, Urgent Care, Emergency Room Care.
Feel free to include in your next employee communication. Click here for a full copy.
Financial
Blue Cross CDHP Study Confirms Behavioral Change- Lowers Healthcare
Spending Significantly
Health Care Service Corporation (HCSC), parent of Blue Cross Blue Shield of Illinois, Texas, Oklahoma and New
Mexico recently conducted a unique study of members who migrated from traditional plans to Consumer Driven
Health Plans (HSA and HRA).
HCSC studied 5 years of data which showed behavioral change in the following areas in which members reduced
healthcare spending significantly:
 Were 4% more likely to take advantage of preventive services
 Reduced healthcare spending by an aggregate of more than 12%
 Were 10% more likely to fill their prescriptions with generics
 Spent 24% less on inpatient hospital services
 Spent 8% less on outpatient services
 Had a 12% decrease in emergency room visits
If the employer group switched completely to the CDHP model with no other plan option choices, there were even
greater reductions. The CDHP program enrollment surpassed 1.5 million members this year which has grown by
double digit increases for the past six years.
ph: (708) 845-3126 • mike.wojcik@thehortongroup.com

3. Health Care Cost Institute's
Inaugural Health Care Cost and Utilization Report
Health Care Cost Institute was created in September 2011 to provide comprehensive data on health care costs
and promote independent, nonpartisan research to analyze what influences use and cost of health care services
in the United States. Summarized in its first report is de-identified data voluntarily provided by Aetna, Humana,
Kaiser Permanente and United Healthcare, four of the nation's largest insurers.
The group studied claims back to 2001 and most recently 3 billion claims on members younger than 65 covered
by employer sponsored plans in 2010. HCCI studies claims by four categories of service: inpatient facility,
outpatient facility, professional procedure and prescription drug. They also compare subcategories for primary
physician and specialist claims, and generic vs. name brand prescriptions.
Prices were found to increase across all categories of service, with outpatient services experiencing the fastest
growth. Unlike other reports, the group found increased spending mostly due to unit price increases rather than
changes in quantity or intensity of services. Comparing 2009 vs. 2010 revealed:
 6.4% increase in average price for inpatient surgical admission $25,469 vs. $27,100
 8.9% increase in average facility price for outpatient surgery $3,163 vs. $3,443
 11% increase in the average facility price of an emergency room visit is $1,195 vs. $1,327
 13% increase in average price per brand name drug
 6.3% decrease in average generic drug prescription
A future report from HCCI will target findings on the Mental Health and Substance Abuse (MHSA)
category. Though a small component of total health care spending, this category has shown an increase in
utilization, length of stays and facility price increases.
For a complete copy of the report click here.
Legal
Healthcare Reform News Alert
The Supreme Court Decision will be the impetus for fueling the next wave of Healthcare Reform. To help
interpret the decision and the impact it will have on individuals, small and large employers, The Horton Group is
offering the following schedule of Webinar and Seminars from experts in the industry. Click here for
schedules. For a copy of the Supreme Court ruling, click here
ph: (708) 845-3126 • mike.wojcik@thehortongroup.com

4. Human Resource
Anticipate Higher Health Plan Enrollment from College Dependents
The Affordable Care Act might be claiming another unintended consequence if parts of the law continue. College
health plans are being forced to update their limited-benefit insurance plans accordingly to meet new ACA
guidelines or drop them. According to the Government Accountability Office, 60% of school plans have coverage
of $50,000 or less for specific conditions, and almost all have payout caps that they will have to do away with by
2014.
Premium costs are increasing as much as ten fold to meet the new guidelines. Families will do the math. With
expanded family options covering dependents to age 26 through employers, more college students will find
themselves on their parent's plan.
As insured families get larger, their family unit costs will most likely see a spike.
Retiree Medical Expenses Grow at Alarming Rate
In 2002 Fidelity Investments estimated a 65 year old retired couple would need $160,000 to cover their healthcare
expenses throughout retirement. Today that number is projected to be $240,000. Important to note, this amount
does not include any costs associated with nursing home care and applies to retirees with traditional Medicare
insurance coverage.
Future retirees would be wise to maximize their contributions to 401K plans and HSA programs to anticipate
future healthcare needs. They should also take advantage of any wellness programs offered by employers today
and practice a healthy life style as a cost containment practice for the future.
Worksite Wellness Initiatives
Insurer's Launch More Anti-Obesity Programs
Some alarming stats from the Centers for Disease Control and Prevention
 More than one-third of U.S. adults (35.7%) are obese.
 No state has met the Nation's Healthy People 2010 goal to lower obesity prevalence to 15%.
 The number of states with an obesity prevalence of 30% or more has increased to 12 states in 2010, from
9 in 2009, and from 0 in 2000!
 Obesity related conditions include heart disease, hypertension, stroke, type 2 diabetes and certain types
of cancer.
ph: (708) 845-3126 • mike.wojcik@thehortongroup.com

5. Insurance companies are searching deep to solve the rapid rise in cost from weight-related illnesses which this
year is nearing $200 billion. The Institute of Medicine published a report claiming 90 million children, teens and
adults are obese. Carriers are trying to figure out how to design coverage to best fit this need. WellPoint and
United Health Care are two leaders in this field. They are going not just to the doctors which they know are in
short supply, but also developing community efforts. Look for more to be announced on these efforts.
This epidemic needs to be addressed on multiple fronts. Whether it is cutting down drink sizes in New York or
changing meals at Disney World or First Lady Michelle Obama's pitch for the new Food Plate replacement of the
Food Pyramid or new school menus, we all have an interest in seeing this situation reverse or at least stop in its
tracks. For more information, research www.ChooseMyPlate.gov.
Industry Spotlights
Containing Healthcare Costs-Proven Strategies for Success in the Public
Sector- A Study Conducted by Government Finance Officers Association
(GFOA)
The GFOA, with a grant from Colonial Life, conducted independent research to identify the most innovative and
effective strategies local governments could employ to contain costs while offering a quality benefit program. The
study included a survey of GFOA members, case studies and secondary sources. The findings were approved by
an independent panel of GFOA members who were experienced in employee benefit management.
Six leverage points were explored that governments could use to manage employee healthcare costs. Within
those six there were several standout strategies that had the best ROI potential. They included:
 Onsite clinics and contractual arrangements with urgent care clinics
 Variable premium contributions including a defined contribution model
 High-deductible health plan and health savings account
 Wellness programs at the workplace
 Self-Insurance
 Cooperative purchasing (more options will become available through Healthcare Reform)
 Value-based insurance design disease management
A report based on the survey, "Containing Healthcare Costs: Proven Strategies for Success in the Public Sector"
is available by clicking here. Also watch for an upcoming seminar sponsored by The Horton Group and Colonial
Life featuring this GFOA study.
Horton Workshops & Webinars
Horton Workshops and Webinars are designed to keep busy professionals current on a range of insurance
related topics. The Horton Group engages some of the brightest minds in the country to help you fine-tune your
professional skills and assist in achieving your organizational goals. Our workshops are offered at several
ph: (708) 845-3126 • mike.wojcik@thehortongroup.com

6. convenient locations throughout the year. In addition, many workshops can be offered at your company location
or for your association or trade group.
As always - if you would like to register for a webinar or workshop, please do so via the following link:
http://www.thehortongroup.com/Insurance_Workshops/
ph: (708) 845-3126 • mike.wojcik@thehortongroup.com