5 compliance areas where brokers should build expertise

There's a lot up in the air right now around healthcare policies and evolving regulations, and this has HR teams concerned about how to balance this in with the broader employee experience. As long as turmoil over public health decisions continues to make news, they will be looking to their brokers for real-world, practical and apolitical guidance. 

As one example, preventive care guidance is up in the air, causing concern among many wellness-oriented employers — particularly those that have achieved measurable outcomes from connecting workers with early intervention programs and services. 

At the same time, sweeping reforms aimed at pharmacy benefit managers (PBMs) are creating a patchwork of rules that vary widely by state, adding new uncertainty around how employees access and afford their medications.

Similarly, Florida's recently announced plans to halt vaccine mandates raise questions for multistate employers attempting to provide a consistent benefits experience across their workforce. 

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We're just barely scraping the surface of the regulatory minefields HR teams are up against so far. But here are some practical steps brokers can take now to fortify benefits plans in the face of potentially significant policy changes. 

1. Get up to speed on transparent PBM contracts 
Having a firm grasp on these agreements will be a major differentiator for benefits brokers and advisers going forward. The ability to not only review but also negotiate these contracts on your clients' behalf will be key to helping employers plan through ongoing volatility in pharmacy benefits. 

2. Become fluent in claims coding tied to state-specific mandates
When it comes to hot-button benefits, such as reproductive healthcare or hormone treatments, the way a claim is coded can determine if it's covered, denied or even deemed illegal. Depending on the legality of the matter in certain states, this could have implications for federal pre-tax payroll deductions. Brokers who can interpret those codes and guide employers in structuring compliant, consistent benefits will become indispensable. 

3. Let claims data guide coverage decisions
If certain services lose their clinically recommended status, encourage employers to take a measured approach. Guide them in reviewing their unique claims history before making any changes. In some cases, low utilization of the preventative service could mean the impact of removing coverage will be minimal. In others, the data may show the service has driven early detection and long-term savings, making it worth continued coverage.

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4. Lean into multiple data sources to help guide strategic decisions
Data is only as good as the analysis applied to it. Brokers should caution clients against taking numbers at face value. If half of pre-diabetic employees progressed to diabetes, it may not mean preventive measures failed. It could mean employees didn't understand, access or stick with the benefit. Outcomes often hinge less on coverage itself and more on communication and education. When benefits literacy is in question, brokers can point clients to emerging AI-based benefits technology that personalizes outreach so employees better understand and use their benefits.

5. Broaden the lens on what drives plan outcomes
Encourage employers to consider benefits beyond traditional medical coverage such as paid parental leave. Research links paid family leave with significant reductions in incidents like infant respiratory infections, easing demand on healthcare services. By connecting the dots between empathetic policies and healthier populations, brokers can help design total rewards plans that deliver value for their clients and employees.

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As every good broker knows, employers don't shape their group health plans in a vacuum. Public debate over healthcare issues often spills into the workplace, shaping both employer decision-making and employees' sense of confidence in their benefits. 

Brokers and advisers can think of this discourse as a strategic opening with clients. By proactively addressing the news of the day with clear, practical insights, they can demonstrate their expertise while calming both employer and employee concerns. In turn, brokers help HR reinforce the benefits plan and protect the employee experience, building trust that employers are making choices that serve both the organization and its people.