For the past few years, I've been writing a guide for CEOs, CFOs and HR leaders aimed at elevating their healthcare and insurance IQ better preparing them to beat the Healthcare Heist. What I've learned during this work is that employers aren't stuck with rising costs because they lack options. They're stuck because of a habit the benefits industry taught them years ago. This habit now affects everyone in the process, including the many highly capable benefit advisers who feel just as frustrated as their clients.
The good news is that transparency rules, new tools and an emerging generation of
Years ago, brokers, carriers and carrier reps routinely told plan sponsors that key information could not be shared. Claims data was "protected by HIPAA." Discounts were "proprietary." PBM pricing was "too complex." Gag clauses supposedly prevented open discussion. Executives eventually accepted the message: meaningful insight simply wasn't available.
This created an unintended consequence. CEOs stopped attending renewal meetings. CFOs stopped asking for visibility. HR leaders carried the entire burden of plan oversight. Renewals became a predictable routine: advisers gathered quotes, executives scanned the spreadsheet and the group selected the least painful increase. The broader leadership team no longer expected transparency, accountability or strategy.
Many advisers experienced the other side of this cultural shift. They tried raising bigger conversations, but clients weren't engaged. They tried introducing innovative strategies, but executives were distracted or overwhelmed. After years of hearing "we just need to get through renewal," even strong advisers hesitated to
Transparency laws changed the rules, but not the mindset
Over the past several years, legislation fundamentally rewired the employer's legal and fiduciary role in overseeing health plans. The Consolidated Appropriations Act, Transparency in Coverage rules, price-posting requirements, broker compensation disclosures and new pharmacy benefit manager accountability measures have opened access to data that was previously unreachable.
The irony is that, despite gaining access to more information than ever, many leadership teams still behave as if the old gag-clause era is intact. They continue operating under outdated assumptions because shifting habits feels uncomfortable, time-consuming and risky. If executives reengage, they feel responsible for the outcome. If they stay uninvolved, the process remains familiar.
Advisers know this dynamic well. Many want to raise their game, but they hesitate to disrupt entrenched client expectations. After all, if leaders don't demand transparency, it's difficult for advisers to justify investing time in a deeper, more strategic process. This mutual inertia
The most expensive decision a company makes is the decision not to change its health plan. Each renewal cycle that relies on old information, old assumptions and old habits compounds the financial damage. Premiums climb. Deductibles rise. Employees carry more financial stress. Recruiting becomes harder. HR absorbs more pressure. Meanwhile, advisers are forced to manage expectations rather than drive innovation.
For employers, the cost of inaction now exceeds the effort required to improve. For advisers, the risk of staying in a passive quoting role is greater than the risk of elevating their relationship. Both sides need a reset.
A new partnership model: break the habit together
Meaningful progress requires employers and advisers to rebuild the process together. Not by adding more work, but by replacing outdated habits with a shared, intentional rhythm.
The first step is reframing the purpose of the plan. Employers are not buying insurance; they are financing access to healthcare for their workforce. Once leaders understand that distinction, it's easier for advisers to position themselves as strategic partners rather than product managers. Conversations shift from premium increases to goals, outcomes and the experience of the people using the plan.
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The second step is establishing a transparent starting point. Leaders need clarity and advisers need access. Claims reporting, pharmacy methodologies and compensation disclosures create a foundation for thoughtful planning. These are not burdens; they are the minimum information necessary for fiduciary oversight. When
The third step is replacing the once-a-year renewal scramble with a year-round process. Quarterly reviews, trend analysis, pharmacy oversight, steerage tracking and member experience updates are not luxuries. They are how employers prevent surprises and how advisers stay relevant throughout the year. When both sides commit to a predictable cadence, decisions become proactive rather than reactive.
The fourth step is using structured tools that hold each other accountable. Broker evaluation scorecards, plan performance dashboards and readiness checklists create a common language. Employers benefit because they can see whether their adviser is driving progress. Advisers benefit because they can clearly demonstrate value beyond quoting. These tools also depersonalize tough conversations, allowing both sides to focus on outcomes, not opinions.
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The final step is building a health plan with intention. A high-performance health plan does not require massive disruption. It requires sequencing: independent TPA support, transparent pharmacy terms, navigation services, accountable primary care, bundled surgery options and a clear plan for connecting members with high-value care. Advisers guide the roadmap; employers provide oversight. Together, they construct a plan that performs rather than reacts.
What happens when both sides engage
When leaders reengage and advisers raise their expectations, everything shifts. Financial waste declines. Members receive better care and clearer guidance. HR teams are no longer stuck in crisis management mode. Advisers regain the professional satisfaction that comes from driving meaningful change. The savings created can be reinvested into wages, technology, paid time off or business expansion.
Most importantly, the organization stops feeling like a passenger in a system it cannot influence.
A shared call to action emerges: Employers don't need to
For advisers, this is the moment to lead with confidence, not quotes. Transparency has given them the leverage they've always needed. It can be used to elevate clients and the profession.
The healthcare system will not change itself. Progress will come from employers and advisers choosing to break old habits and build something better together.
