Endless worrying about the state of U.S.
"Let's face it, we are an unhealthy country," says Debbie Burke, VP of employee benefits for Insurance Office of America. "People really need to go to the doctor. There are too many of us who have chronic illnesses. We're on multiple meds, and diabetes and obesity are taking a toll."
What's potentially life changing, she says, is when advisers start plugging in best-in-class solutions to help the employee populations they serve get healthy and reduce the burden of rising out-of-pocket costs.
A $3,000 annual deductible would be 10% of gross income before taxes for minimum wage earners who make $30,000 a year, explains John Clay, a healthcare supply chain manager who owns BetterSource Benefits. "You're talking about putting people in poverty," he says.
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Affordability is also a major challenge on the employer side. "My biggest concern is that we aren't able to help small employers," says Aaron Witwer, a benefits and health equity adviser who is president of BenEngage.
He notes that designing progressive health plans featuring third-party administrators and
By replicating what they're doing with larger groups, Witwer believes advisers would be in a far better position to serve this segment, noting that most U.S. employers are under 50 lives. "There's still plenty of money to be made [in this market]," he adds.
Seeding more market collaborations will enable smaller groups to achieve economies of scale. If enough of these employers band together, Witwer says they will be able to secure lower rates and build something like a group captive that shares reinsurance with like-minded companies that have as few as two lives. "We haven't gotten there yet," he says. "That's what I'm pushing for. We've got to get ourselves together and pursue a better grassroots effort collaboratively."
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Another challenge is the growing divide between urban and rural healthcare. Eugene Starks, a principal with Acuity Group, says access to care in rural communities is a national problem. Still, there are solutions at hand. "I spoke with a client outside of Jackson, Miss., and we're setting up pilot projects for direct primary care relationships for their critically ill and active disease state like diabetes and obesity," he says.
While this approach holds promise, it hasn't gained enough traction for other advisers to take notice. Only 2% of U.S. employers couple the direct primary care model with RBP, Starks says. "If we can get to 25%, it's going to be a lot more familiar so people won't be as resistant because you're going to need carriers that will assume risk on large populations, particularly the smaller groups," he explains.
While most advisers are fixated on
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Following a 90-day suspension, he went two counties over and hung a new shingle – still in business as a PPO provider. "We will cancel people over the dumbest garbage," Clay says, "yet you can maim or disfigure somebody, permanently impair them in a surgical situation, and they're not canceled for shit."
Ultimately, the goal of advisers is to identify and vet high-performing healthcare organizations that consistently deliver better clinical outcomes and lower cost than conventional approaches, says Brian Klepper, a principal with Worksite Health Advisors. Among the areas he is focusing on: management of chronic disease,
Over the past decade, Klepper has discovered about a dozen companies that fit this bill. His favorite is has developed an artificial intelligence-driven tool that guides physician prescribing for major chronic diseases, 13 of which he says account for about 80% of all healthcare spending.
"We've done two pilots with this tool, and both of these groups got their hypertension populations to 94% control," he reports. "So if you do this one thing, you're talking about a drop in total healthcare spend of somewhere between 15% and 20%."
