Career moves: Navigating conflicts of interests as a healthcare adviser

By Bruce Shutan May 28, 2025, 7:00 a.m. EDT 2 Min Read

Part two in an on-going series about how these former retirement advisers transitioned to healthcare consulting. Read part one here.

With fiduciary stakes rising for health plan sponsors, more retirement pros have explored growing opportunities to lend their expertise for better compliance.

On the healthcare side, Barbara Delaney, founder of StoneStreet Benefit Advisors, says employers that are content with their renewal being down from 40% to 20% don't realize that brokers are being compensated by health insurance companies, and their firms are getting bonuses to steer business that way. Noting the potential conflicts of interest between Aetna, CVS Caremark and doctors in the same vertical, she says "we can't have these conflicts of interest and not disclose compensation. We really would wind up being barred from our business."

The fiduciary stakes for advisers were raised when first retirement and then health plans shifted from a defined benefit to defined contribution model — both areas always under the aegis of ERISA as price transparency finally began to take hold in the healthcare market since passage of the Consolidated Appropriations Act of 2021, known as the CAA. It meant employers had to be more prudent stewards with the dollars they're withholding from employee paychecks, Greenleaf notes.

The trouble with many benefit consulting firms today is that they don't view the CAA as a game changer like Delaney and others who've moved from the retirement to healthcare arena. O'Toole describes the CAA as "a rinse and repeat of the Pension Protection Act."

Lessons learned

In recent years, Greenleaf has been teaching other advisers about the critical role fiduciary oversight plays in the healthcare space. It was standing room only in the beginning from curious students who included retirement consultants eager to deploy their expertise for use with health savings accounts because they involved investments.

But attendance significantly waned when advisers quickly realized it required tremendous effort on their part and the small amount of money they would make on the tiny accounts. Aggregators also were buying up benefits, retirement and wealth-management shops that preferred to stay in their respective silos.

Interest started to peak again when retirement consultants started to recognize that they could help facilitate conversations without understanding the healthcare side or being a healthcare broker because they knew the fiduciary issue so well. In the face of mounting pressure from the CAA to level up on fiduciary stewardship, interest is now rising quickly for several reasons. Chief among them: Retirement consultants understand the fiduciary process and employers are starting to ask questions.

She says the conversation these days is not about the convergence of health and wealth so much as it is about "mitigating the risk associated with running benefits in an ERISA based litigious society, and allocating proper dollars and resources across these benefits to ensure that they can recruit, reward and retain their employees."

Bruce Shutan

Contributing writer