CBIZ's very own Todd Hanson is featured in the November edition of the Minneapolis St. Paul Business Journal. Read the panelists' expert opinions about current issues surrounding health care including benefits, mobile health, health education, aca compliance, and more! Panelists include Todd Hanson, director of client services at CBIZ Benefits & Insurance Services; Jesse Berg, an attorney specializing in health care law at Gray Plant Mooty; John Soshnik, a partner in the health law group at Lindquist & Vennum; Becca Miller, director of employer solutions at Capella Education Co.; and Steven Rush, director of health literacy innovations at UnitedHealth Group Inc. Allison O’Toole, interim CEO at MNsure, served as moderator.

1. 24 MINNEAPOLIS/ST. PAUL BUSINESS JOURNAL
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HEALTHCAREHEALTHCARE
SPONSORED BY

2. NOVEMBER 13, 2015 25
Allison O’Toole has been MNsure’s interim CEO since May. Previously, she served as deputy director
for external affairs and was MNsure’s staff liaison to the board of directors. She was responsible
for the implementation of the second phase of MNsure’s multimillion dollar marketing campaign.
Prior to MNsure, O’Toole was a director at Himle Rapp, state director for U.S. Sen. Amy Klobuchar,
chief deputy county attorney for Carver County and assistant county attorney for Hennepin County.
O’Toole has a bachelor’s degree in government from Franklin & Marshall College in Lancaster, Penn.
She earned her Juris Doctor from William Mitchell College of Law in St. Paul.
Allison O’Toole • MNsure
Jesse Berg is an attorney at Minneapolis-based Gray Plant Mooty. He counsels health care
providers on federal and state anti-kickback laws, the Stark physician self-referral law,
Medicare and Medicaid reimbursement, enrollment and participation issues, HIPAA, and
state privacy and confidentiality matters, as well as federal and state antitrust issues. Prior
to Gray Plant Mooty, he served as assistant attorney general in the health care and antitrust
division of the Minnesota Attorney General’s Office.
Jesse Berg • Gray Plant Mooty
Steven Rush is director of UnitedHealth Group Inc.’s Health Literacy Innovations Program,
an enterprise-wide program to help consumers understand and use health and wellness
communications. Prior to this, he was director of physician engagement at UnitedHealthcare
Health Services. He is a licensed psychologist. His interest in health communication has
been a natural part of his work in psychology and intensified about 14 years ago when he
was the practice and patient safety manager for the American Academy of Neurology, and
was one of the first group of trainers trained by the American Medical Association.
Steve Rush • UnitedHealth Group Inc.
Todd Hanson has been director of client services and senior benefits consultant at CBIZ
Benefits & Insurance for over five years. His past experience includes the health and
productivity leader role at Buck Consulting, where he provided benefits consulting, as well
as delivery of various human resources services. He also has worked as a benefits practice
leader for Marsh/Mercer and regional group manager for MetLife and ING Reliastar. Hanson
has experience with privately held companies, public companies, health care industry
clients, governmental entities and multi-employer plans.
Todd Hanson • CBIZ Inc.
Becca Miller is a senior director for Capella Education Co. She is responsible for driving Capella’s
strategy for employer partnership development. Since joining Capella in 2001, she has held
progressive leadership roles in enrollment, advising and operations. As the director of enrollment
and advising for the College of Professional Studies, she led a team of enrollment, advising and
operations leaders to deliver high-quality, highly differentiated programs for learners. Her previous
experience includes recruiting and advising positions with Hibbing Community College and
Sopheon. Miller holds a master’s in education from Capella University and Bachelor of Science in
communications from University of Minnesota–Duluth.
Becca Miller • Capella Education Co.
John Soshnik is a partner at Lindquist & Vennum, representing health care clients on a broad range
of transactional and regulatory matters. His clients include hospitals, physician groups, health
systems, health care professionals and licensed entities, managed care organizations, third-party
administrators, wellness service providers, disease management companies, medical device
companies, and technology companies. He has experience in all aspects of HIPAA privacy issues
(and their state law counterparts), including breach response, contract negotiation, and policies
and procedures.
John Soshnik • Lindquist & Vennum
MODERATOR
PANELISTS

3. 26 MINNEAPOLIS/ST. PAUL BUSINESS JOURNAL
BY ELIZABETH MILLARD
Contributing writer
T
he Minneapolis/St. Paul Busi-
ness Journal held a panel dis-
cussion recently, featuring five
expert panelists to explore top-
ics about the issues surrounding
health care. Panelists included Todd Han-
son, director of client services at CBIZ Ben-
efits & Insurance Services; Jesse Berg, an
attorney specializing in health care law at
Gray Plant Mooty; John Soshnik, a part-
ner in the health law group at Lindquist &
Vennum; Becca Miller, director of employ-
er solutions at Capella Education Co.; and
Steven Rush, director of health literacy
innovations at UnitedHealth Group Inc.
Allison O’Toole, interim CEO at MNsure,
served as moderator.
O’Toole: I’d like to start with some
big-picture issues, and let’s begin with
UnitedHealth. Steve, you’d mentioned
that October is Global Health Literacy
Month, so tell me what you’re seeing in
that arena.
RUSH: Global health literacy month is
a worldwide opportunity to bring some
focus on the need to create simple, acces-
sible and actionable health communica-
tions. Even in the most complex health
care environments, it is important to
have simplicity. At UnitedHealth Group,
we’re working to create some standards
by which we can communicate in ways
that people can understand and use. We
also want to raise awareness of the bar-
riers to health communications that are
associated with low health literacy — and
there are a lot of them. We feel people need
to understand health care and insurance
terms, and even some of the legal terms.
O’Toole: Are there some groups that
are more challenged than others?
Who needs the kind of health care
information that you’re providing?
RUSH: Everyone needs simple, under-
standable and actionable health commu-
nications. There are some groups of peo-
ple for whom this type of communication
is more important: people who do not
have English as a primary language and
people who have low literacy skills. Also
when people get sick, their illness can cre-
ate a communications burden, which can
be difficult to overcome. So, we need to
address that. You can’t always tell which
person has low health literacy, so we have
to create materials designed for a broad
approach.
HANSON: It’s ironic, too, that when you
go to a health care provider you get some-
thing called an explanation of benefits,
but we’ve found that most people don’t
understand that document. This docu-
ment that’s supposed to describe a recent
claim — what’s covered by the health plan
and what isn’t covered, what’s paid by
the health plan and what the person has
to pay everything they need to know — is
not understandable. That makes health
care literacy a huge need. We work with
employers, and communication is a big
part of what we do for them. Employ-
ees need to understand the health plans
that are offered. They also need to have
information to choose the right provider.
This all rolls up under the health literacy
umbrella.
O’Toole: How are companies using those
health care benefits to attract and retain
employees?
HANSON: As health plans cost more
and more, voluntary plans have filled a
need. Employers are almost having to
pull back a little bit, because if you offer
an overly generous plan, you may have to
pay an excise tax in 2018. This is the Cadil-
lac Tax under ACA. Employers are using
voluntary plans to fill the gap to lower
the premium and lower the cost. Also, in
terms of attracting and retaining employ-
ees, what we’re seeing is a transition from
wellness to well-being. It’s not just physi-
cal wellness, such as whether you smoke,
nutrition or your weight, but it’s now
extending to other aspects like the role you
play in your community, if you feel socially
connected, do you feel a sense of spiritual
well-being, are you financially solid. All of
those areas affect productivity, and they
are very important to employees, so a good
well-being program helps in finding the
right employees and helps to keep them.
SOSHNIK: We’re seeing many creative
health-benefit solutions being considered
and developed by companies. Some are
quite promising, but the parties involved
need to keep in mind the serious compli-
ance issues that are involved with these
products and plans. We work hard with
clients to help them innovate and improve
health care for their constituents while
remaining compliant with the maze of
health care regulations that apply in this
arena.
O’Toole: Let’s talk about the integration
and incentive to work together. With
all the mergers and consolidations that
are going on, what do you think will
happen?
BERG: This year alone there have been
71 hospital consolidations, so that puts
us on pace for the largest number since
1999. And it’s a great question to ask: Why
is that happening. And one of the biggest
reasons is the Affordable Care Act, which
has initiatives that are intended to push
providers towards working together. This
includes things like reimbursement that
rewards managing large patient popula-
tions, implementing performance-based
reimbursement programs, assuming risk,
better sharing of data and leveraging infor-
mation technology. All of these have a
huge cost, all of them take management
and centralized authority, so that forces
providers into a place where they need to
think about working together. And that’s
easier to accomplish in a large, integrated
system.
SOSHNIK: One of the biggest factors for
my clients is that they’re being asked to
take on more risk, and that’s easier to do
if you have the volume to absorb that risk.
Also, for physician groups, especially for
certain specialties, reimbursement may be
changing as the health care model evolves.
The uncertainty surrounding where reim-
bursement is going, along with expecta-
tion of increased risk sharing, has moti-
vated some physician groups to sell their
practice and integrate with hospitals and
health systems.
O’Toole: How does this all impact the
consumer?
RUSH: Health care and health insur-
ance is extremely confusing to patients.
They aren’t prepared to be able to accept
that burden. We live in a chronic care
environment. There are a lot of people
with heart problems and back problems
and diabetes and other chronic condi-
tions. All of those are very costly. Ninety-
five percent of the care necessary to man-
age those problems is within the power
of the patient, but they don’t know how.
So, one thing that providers may need is
to change their communication to better
engage patients. Some providers say that
takes a lot of time and money, and that’s
true, but only at the beginning. And it’s a
compensated approach.
SOSHNIK: I think some of the inno-
vations are trying to accomplish that.
The ACO product, for example, provides
incentives to primary care providers to
successfully address chronic conditions
and manage their patients’ overall health.
O’Toole: Let’s hear a little bit about
mobile health tools. What challenges
and opportunities are we seeing because
of those?
BERG: There are a lot of exciting oppor-
tunities in that area. I think of mobile
health as running the gamut, from Fit-
NANCY KUEHN
From left: Allison O’Toole, MNsure; John Soshnik,
Lindquist & Vennum; Becca Miller, Capella
Education; Steve Rush, UnitedHealth Group; Jesse
Berg, Gray Plant Mooty; Todd Hanson, CBIZ

4. NOVEMBER 13, 2015 27
bit to tools that providers can use to treat
patients remotely. This is terrific for patient
care because it provides a way to bring
care to rural or underserved populations.
Providers can make clinical and educa-
tional information available to patients,
communicate with them and generally
make them feel more involved and invest-
ed in their own care. So, there are a lot of
really positive things coming out of this
trend. There are some challenges, and
the scope of these challenges will involve
how complex this technology is. On one
end of the spectrum are tools that pro-
vide educational information to patients,
but don’t facilitate direct communication
between patients and providers or don’t
allow providers to reach into the cloud and
pull out health information. On the other
end of the spectrum are tools that permit
patients to connect directly with their pro-
viders and to receive care over the Inter-
net. But when you get into technologies
where patients and providers are exchang-
ing clinical information, that’s great but
it creates potential licensure issues if the
patient and provider are located in differ-
ent states. If medical information is stored
in the cloud, another question is whether
the technology vendor is meeting HIPAA
requirements.
HANSON: I’d add that one of the ben-
efits we’ve seen is a transition of nurse
lines to telehealth and Web-based deliv-
ery of health. Even with problems you’ve
mentioned, we’ve seen a big growth in this
area. That’s a low-cost, high-value option.
BERG: One other thing to add is reim-
bursement rules are really behind the
times when it comes to telehealth. Medi-
care only started reimbursing providers
for telemedicine services in 1999. And
there’s still a very limited list of things
that will be covered. It seems like the folks
writing these regulations are really behind
the times in terms of what providers are
doing, and unfortunately, a lot of reim-
bursement policy in the country is driv-
en by decisions that Medicare makes. So,
hopefully that will change in the future.
RUSH: I think the concept of mobile
health does open up a new area, called
e-health literacy, that requires more of
the consumer. Not only do they have to
know about technology and computers,
but also science literacy and health litera-
cy. Also we need to think about the thou-
sands apps. We have to look at how they’re
being used.
O’Toole: Let’s shift gears a little bit and
focus on workforce development and
helping health care employers find
solutions, such as finding nurses.
MILLER: I think many of the emerging
topics in health care that we are discussing
relate to what we do at Capella. In terms
of topics like telehealth and transition-
ing to community- and population-based
health, we work closely with employer
partners to identify where gaps in knowl-
edge and skills exist in their workforce.
We then develop or revise our curricula
in accordance with these. We use a com-
petency-based education model to teach
and assess relevant competencies that are
professionally aligned.
O’Toole: Are there certain benchmarks
that are impacting the education space?
MILLER: Yes, based on substantial
research evidence, the National Acade-
my of Medicine (formerly known as the
Institute of Medicine) is recommending
that 80 percent of nurses have their BSN
degree by 2020. Currently, the percentage
is about 50 percent. That’s a very aggres-
sive goal, but we’re seeing some health
care organizations get close to that. The
seminal piece of research upon which the
recommendations were based suggested a
10 percent increase in the proportion of
BSN nurses on a hospital staff is associ-
ated with a 4 percent decrease in deaths.
Since that study, further research has sug-
gested decreases in certain negative conse-
quences of hospitalization and treatments
with increasing percentages of BSN-edu-
cated nurses. In addition, studies point to a
positive correlation in higher nursing edu-
cation and patient satisfaction.
O’Toole: Tell us about how you’re
educating and reaching employers to get
their workforces to the level they want.
MILLER: One of the trends we are see-
ing is with the amount of mergers and
acquisitions. Many organizations are
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For information on future Table of
Experts, please contact Kathy
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Saluting the Minneapolis/St. Paul Business Journal
Table of Experts on Healthcare participants for striving
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Better
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5. 28 MINNEAPOLIS/ST. PAUL BUSINESS JOURNAL
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BENEFITS CONSULTING
& ADMINISTRATION
HEALTH CARE REFORM
WELLBEING CONSULTING
INSURANCE & RISK
MANAGEMENT
SERVICES
RETIREMENT SERVICES
looking for programs that can bring their
workforce together. We have been respon-
sive to this in the development of two
competency-based RN-to-BSN program
options. Our standard credit-based pro-
gram is a 10-week session with required
learning activities facilitated by a facul-
ty member and set time lines for assign-
ments and other course requirements.
We also have our revolutionary FlexPath
option, which is not tied to credit or con-
tact hours and allows learners to move
through competency assessments at their
own pace. Learners can use any resourc-
es they want in preparing to demonstrate
competencies, including prior profession-
al experience. Therefore, learners do not
have to spend time on what they already
know; they can demonstrate competency
in an area and move on. Proportionately,
more time is spent on topics with which
they aren’t familiar. It just makes sense. It
is a very learner-centric and empowered
approach to higher education. However,
it is not right for everyone for numerous
reasons, including relative lack of profes-
sional experience.
O’Toole: Do you think others are doing
enough to support this aggressive goal?
Is there any collaboration?
MILLER: I think there’s always room
for more collaboration between employers
and educational institutions. It’s impor-
tant to understand what an employer
needs and to develop curricula that aligns
to industry standards. We have to work for
them and with them in creating the best
solution. There needs to be even more col-
laboration and validation that the curricu-
lum is meeting tomorrow’s needs.
HANSON: I think that’s a very good
point, and it brings up another point,
which is employee engagement. The more
you can offer education and improvement
of job skills, the more you engage your
employees.
RUSH: I’ve talked with many col-
leagues about health literacy and nursing,
and nursing has at its core curriculum for
many years this concept of patient educa-
tion and counseling. One of the things that
happens when people go out and practice,
they lose that initial training. One of my
colleagues, who was a nurse for 35 years,
has retired and is creating curriculum to
re-engage nurses in health literacy. So, my
thought is the ongoing stress on health lit-
eracy is really important, and it does take
a community approach.
SOSHNIK: One interesting develop-
ment occurring now is the broadening
of the scope of practice for nurses. As
nurses are allowed and expected to pro-
vide more independent medical care, it is
important that their roles in patient edu-
cation and counseling are not devalued or
de-emphasized.
BERG: From the provider point of view,
some of the laws around accountable care
organizations are aimed at getting the
patients invested and involved in care.
Meanwhile there’s an obscure law called
the civil monetary penalty statute that
says the providers can’t improperly induce
patientstocomeandgetcarefromthepro-
vider, and the idea is that the doctor can’t
be handing out gift cards to get patients to
come in. So, providers are in a tough spot
because they want to get patients to come
in and they want them invested in their
own care, but they have to be careful that
what they do doesn’t cross the line into
improper inducement.
SOSHNIK: Similarly, the current push
towards reimbursement based on quality
metrics could be seen as in conflict with
fraud and abuse laws. For example, under
health reform, providers can be rewarded
forcontributingtolowerhospitalreadmis-
sion rates. In the past, incentives related
to hospital readmission rates were consid-
ered an indicator of potential fraud issues.
RUSH: From a provider standpoint, it’s
interesting that hospitals are getting pun-
ished for having higher readmission rates,
and those tie into the fact that people don’t
understand their discharge instructions.
If you think about those instructions in
meaningful-use terms, you have to think
about the extent to which patients can use
them. Some of those documents are eight
pages long. I don’t read eight pages.
O’Toole: At MNsure, I’m dealing with
such a small part of this whole industry,
so it’s fun to hear about this broader
work. But the ACA really turned the
consumer engagement on its head
and is requiring consumers to be so
much more involved and to behave in a
different way then they have been. We’re
seeing such a need for the literacy piece.
RUSH: You bring up engagement, and
how difficult it is, and the research would
indicate that people with low health lit-
eracy typically don’t have the confidence
to ask questions, and typically don’t feel
they have control over their health care, or
that they have the right to ask questions.
Our health care in the past has said, “We’re
the professionals. We’re going to tell you
what to do.” And now that’s turning the
paradigm for providers and patients, and
that’s difficult.
O’Toole: Let’s shift to talking about
another major topic around health care,
and that’s fraud and abuse. What kinds
of issues and challenges are you seeing
there?
BERG: We always hear, “How can we
cut back on health care costs?” and one
of the big things that always comes up is
waste, fraud and abuse, and how there’s
so much in the system. Providers are frus-
trated by that because the rules are com-
plicated and most providers really do their
best job to comply with all these laws.
Health care is the second most-regulated

6. NOVEMBER 13, 2015 29
industry in the U.S., behind nuclear pow-
er. You’ve got doctors and nurses trying
to sort through complicated rules, and
meanwhile, the enforcement environment
is terrifying. Last year, the Department of
Justice recovered $2.3 billion just from
health care fraud. And that’s five years in
a row where they’ve recovered over $2 bil-
lion just from health care fraud. So, while
fraud and abuse is out there, most provid-
ers are doing their best. Everyone in this
industry is finding that it’s taking more
time and effort than ever before to try to
sort through all these regulations, and
honestly, that takes energy and resourc-
es that could have been spent on things
like health literacy or really engaging the
patients.
SOSHNIK: There are so many potential
compliance pitfalls out there now, and
anyone in the health care field needs to
remain vigilant. Serious compliance issues
can arise from seemingly reasonable and
innocent activity.
O’Toole: Thinking about compliance,
security and privacy, and all the
information coming in from so many
different directions, how are you
advising your clients or consumers to
navigate this?
SOSHNIK: It gets back to the basics
and just having solid compliance in place.
Whether it’s a provider, vendor, a health
plan, having a robust, but basic compli-
ance program that covers the basic bread-
and-butter health care issues is important.
You also need to cultivate a culture of com-
pliance in the company, where that’s not
the last hurdle, but it’s part of the build-
ing process. Keep it in mind at the design
phase, not just as a way to clear legal.
BERG: I would just add to that, the
Office for Civil Rights, which is the agen-
cy that enforces HIPAA. They put out some
great guidance and have done a nice job
of putting out audit tools that you can
use to evaluate your internal policies and
procedures. One of the things every cov-
ered entity has to have is a robust security
assessment and evaluation. They have to
think about what they’re doing to secure
electronic communications, maintain
backups of health records and take steps
to address any vulnerabilities identified in
the course of the security assessment. Pro-
viders and plans need to be able to show
their homework. It’s like math class when
you were in school, where it’s less impor-
tant to get the right answer, and more
important that you can show the steps
you took to get to that answer. Regulators
want providers and plans to show what
they have done to try and achieve compli-
ance. The other thing is that privacy is the
one thing that everyone in health care can
relate to. Everybody has been to the doc-
tor and everybody has had some worry or
experience about identity theft. So, it’s a
huge area of focus, and I think we’ll see
more investigations in this area.
O’Toole: I think that comes back to
literacy, and what’s happening with
companies and individuals when it
comes to protections. What are you
seeing?
HANSON: From the employee benefits
consulting perspective, compliance has
become a bigger part of what we deliver.
Now with the Affordable Care Act, prep-
ping for the Cadillac Tax along with HIPAA
concerns, compliance has become a large
part of the services delivered to employers.
RUSH: In terms of a consumer’s per-
spective, there’s certainly a concern about
sharing health information. We tell peo-
ple that we’re collecting this data, but it
will be confidential. UnitedHealth Group
has an aggressive compliance program so
we can help patients and providers bet-
ter engage. We continue to work on that.
MILLER: It comes back to our respon-
sibility of keeping curriculum up-to-date
on evolving fields like informatics and
data analytics. There is so much data.
The health care workforce not only has to
understand how to use it, but also how to
protect it.
O’Toole: What are you most excited
about? What’s coming down the pike
that you look forward to seeing?
HANSON: Some of the benefits trends
that we’re working with are exciting. We
talked about telehealth and Web-based
health,orvirtualhealthdeliveryasagrow-
ing segment. We’re working with employ-
ers on defined contributions, which is
now gaining traction. Another trend is
concierge approaches, then there’s on-
site clinics. That used to be just for large
employers, but now it’s coming down to
medium size. The transition from employ-
ee wellness to well-being is important. So,
there are half a dozen things that are com-
ing and it should be very interesting.
RUSH: I think we’re in a perfect storm.
We have an aging population, and as they
age, they have difficulty processing new
information and there’s a ton of new info
related to health care coming down the
pike. We also have our newest generation,
and they’re better educated, but they also
have the widest gaps in terms of health
care knowledge. We also have more people
who are new to the United States and don’t
understand our health care system, which
is becoming more complex. Then you have
innovation coming in. All of this will be a
challenge, but also an opportunity.
SOSHNIK: I am looking forward to see-
ing how many of the current innovations
being rolled out in the Medicare program
will be integrated into the commercial
market. I look forward to seeing how some
of these innovations will actually improve
health care and the overall health of our
population. Overall, I am optimistic about
the direction health care is moving.
MILLER: One of the things I’m most
excited about is increased collaboration
between employers and educational insti-
tutions. Health care and higher education
have many similarities in terms of needs
for transformation. Increased access and
affordability is key to reform in both areas
and finding new ways to meet the chang-
ing needs of the health care profession. It’s
an exciting time to think about what the
next models will look like.
BERG: I’d say that what I’m most excit-
ed about is a sub-agency called the Cen-
ter for Medicare and Medicaid Innovation,
which came out of the Affordable Care Act.
The idea is to really incentivize individuals
and organizations to come up with new
and innovative models of care delivery
and give them financial incentives to try
and makes these new innovations a real-
ity. Overall, I just think we’re finally see-
ing the silos that have been in health care
begin to break down, and that is a very
welcome change.
PHOTOS BY NANCY KUEHN
From left: Todd Hanson, CBIZ; Allison O’Toole, MNsure; Jesse Berg, Gray Plant Mooty; John Soshnik, Lindquist & Vennum