Since founding their Omaha, Neb., brokerage in 2004, Midwest Benefit Advisors partners Tim Longwell and Howard Shandell have made it their mission to improve healthcare transparency and find a better way to serve employees. Last year, they came across “a huge opportunity” to accelerate that goal, Shandell says, in partnering with medical management firm Ault International Medical Management, or AIMM.
In what AIMM’s president Deb Ault, a registered nurse, describes as “the five Rs,” the company helps plan members get the right care, at the right time, in the right place, for the right price, while ensuring they are the right patient for a particular procedure.
Midwest Benefit Advisors had worked with other data-driven analytic medical management firms before, but Longwell says he and Shandell were drawn to AIMM for its clinical-based solutions, meaning it has doctors and nurses helping employees make effective healthcare decisions.
“They know the clinical side, but they also know the insurance side, and they can bridge that gap between the carrier and the plan member and the provider,” Shandell adds. “Because they're a team of nurses and doctors, they can speak the same language as the providers and the plan members and also speak to the people in the insurance companies.”
A chief benefit of AIMM is its case management services, Shandell says. If a plan member might need a surgery, AIMM will look at all of the alternatives — could they do physical therapy instead? — and if the procedure moves forward, they will help the plan member identify high-quality, low-cost facilities.
“The more plan members have access to that type of support, the better the medical outcomes will be and you'll have lower healthcare costs,” says Shandell. “They go hand in hand.”
On Jan. 1, Midwest Benefit Advisors introduced AIMM to four of its employer clients, who pay for the service with a monthly fee per covered employee. The ROI is already coming through.
For example, the owner of one of the businesses that instituted AIMM was in the hospital on a Friday afternoon, ready to be discharged. He hit an obstacle with his insurance company’s approval process for the oxygen he needed to take home with him. AIMM jumped in, and within an hour he was discharged, oxygen in hand. The client got what he needed and saved his plan the added expense of two days of additional in-patient days in the hospital, as he would have otherwise needed to stay until the following Monday, Shandell points out.
The AIMM objective, says Ault, is to facilitate the highest quality healthcare at the most reasonable prices. “We want them to see that … it is possible to help the patients covered by their plans to navigate both the healthcare delivery and health plan systems efficiently and effectively,” she adds.
A new energy
While it works seamlessly with self-funded plans, bringing in AIMM as an additional solution for fully insured clients also serves as a bridge for Midwest Benefit Advisers to move those clients to a partially self-funded environment in the future. For fully insured groups, the platform can sit alongside their health plan and help plan members navigate the system, Shandell says. “All the while, we're collecting data,” he adds. “The more data we have about an employer and their plan members, the better we understand the risk and the better pricing we can get” in a more self-funded environment.
It’s been invigorating to move away from status-quo advising, where simply spreadsheeting rates while claiming top-notch service is the norm, Longwell says. “It’s re-energized us,” he adds. “We feel really good that we have some great solutions that are impacting the employees’ lives as well as reducing the cost of healthcare investment for the employer.”
Actuarial and consulting firm Milliman notes that 20% of healthcare costs come from fixed expenses, such as plan administration, but the other 80% are variable. Working with AIMM, Longwell says, helps Midwest Benefit Advisors impact the latter. “If you can help employees become healthier and educate them in the process, they will have better outcomes,” he says. “That's the 80%. That's where all the savings are, for everybody.”
Longwell and Shandell plan to continue offering AIMM’s services to more of their employer groups, primarily groups of 50 lives or more. “We feel we'll really have an impact in helping employees stay healthy and become healthy,” Longwell says.