Brokers/advisers: Not your average plan design: As benefits get more creative, how should purchasing strategies change?

How can we better help clients prioritize offerings and meeting the needs of their workforce?

Transcription:

Alyssa Place (00:08):

My name is Alyssa Place. I'm executive editor at Employee Benefit News. Today I'm joined by this group of panelists, Dr. Cristin Dickerson, founder and CEO of Green Imaging, which provides affordable imaging services for CT scans, MRIs and mammograms. Lester Morales, founder and CEO of Benefits Consulting Company, next Impact, and Jessica Beames, VP and regional Consultant of Business development and operations for Bach Financial Insurance. So thank you all for joining us today we're going to be talking about plan design, and when we were having this conversation in preparation, one of the things that came up is that we really need to get to know our audience a little bit and see what are some of those pain points. So, we'd love to hear from you in terms of how many people in this audience have a hundred employees or fewer. So we got one guy. How many have a hundred and above? And how many of those employees do you think or do are living paycheck to paycheck? Okay. All right. So hopefully that gives a little bit of insight into where we're at today. And so I wanted to start by doing a little bit of a check-in with some of the pain points that you're hearing as advisors and plan designers when you're thinking about some of those challenges that employees and employers are facing. What's coming up for you in today's world?

Cristin Dickerson (01:35):

I think what I'm seeing at Green Imaging is most of our members, most people who have green imaging as a benefit in their health plan, have a zero out-of-pocket plan. They're a number that have a qualified high deductible healthcare plan, and they have money on their hsa. But people who are trying to pay for care, we traditionally have had about 10% self-pay individuals approaching us for imaging. They're not happening. 50 to 70% of people right now are living paycheck to paycheck. We know that cancer diagnoses are down. We know that other acute care is going way too long and costing a lot more lost time from the workplace, more money down the line. And we have a real crisis in people being able to afford and acquire medical care who don't have. Employers can offer better care at zero out of pocket for these employees, still save with us 30, they can still save 30% on their imaging, but give this to the employees at zero out of pocket and get them the care they need.

Lester Morales (02:40):

So I think we're in unprecedented times. I mean, take every buzzword that's out there, inflation, the great resignation, whatever it is. And when you look at that and let alone compound that over one period of time, you've got employers that are saying, Hey, I can't afford what I'm doing today. I've got my employees that every year. If you think about what typically cost control is, it's raising deductibles and raising out of pockets when the gas price of gas is $6 and a gallon of milk is four. So the reality of this is you compound that all in one. And we're in a time that as insurance advisors, as consultants, as again put in whatever word it is approaching this year, it was any other year in my opinion, is doomsday. And so when you take that now, put it in the consumer standpoint. And I think a lot of people know my story. My parents filed bankruptcy when I was 17 years old because of healthcare reasons. So, and they were two working middle class families. So to think that we don't have an issue when an average person has a three or four or $5,000 expense when they go use real healthcare, it doesn't make sense. So this is real, and I think that that's the main theme. I think when I think of the trouble in the problem that we have out there is let's not even talk about, we're talking about everyday people. And their lives.

Jessica Beames (04:07):

I think it's echoed what the two of them said. I think our recruitment tension for employers is also really top of mind, more so than ever. I hear from a lot of my clients that they're wanting to leverage their benefits to retain the employees they have and then be competitive in the marketplace. And they've realized that the things that they had been doing and what they have in place today is not allowing them to do those two things. It's also not rewarding their employees that have been there and been loyal. And so they're looking at different benefit strategies to the point that these two mentioned to offer free benefits because they're not able to give them merit increases or increase their wages for different reasons from just normal day-to-day business challenges as well from covid. And so they're looking to get creative.

Alyssa Place (04:50):

And I mean obviously employers are offering some of those benefits that you see a few saying, I'm going to offer this free thing or that free thing. But what do you think is leading to some of this missing link between you see premiums going up, the cost of healthcare going up, people are struggling, why aren't these two groups connecting?

Cristin Dickerson (05:09):

I think it's a disconnect between what people think is quality in healthcare. There is no direct correlation between quality and cost in healthcare in this country. And what hospital systems do is they're integrated and they make it really easy to send the patient down the hall. That's the way people down the hall mentality. Where's the most expensive place to get an mri? It's down the hall. And that kind of people are so used to getting their healthcare that way. Employers think they need these big hospital systems and their health plans. And those are actually, when you look at the claims data, those places are hijacking them. The reason they can't give those better wages are because they're spending so much on this traditional healthcare to get these hospital systems. Now with private equity is the new bad guy. But to get these hospital systems into their health plans, they're paying more and more and their hospital systems are not providing better care or more affordable care.

Lester Morales (06:12):

I think the word is education. Our entire industry for the last X number of decades has operated the same way. Quite honestly. I think as an industry, we should be ashamed of ourselves. I mean, I always say this to advisors when I work with them. Hey, as an industry, if we don't start the movement, it's not changing because it's easy for an employer to hit the easy button, which is, Hey, we're going to raise deductibles, we're going to raise out of pockets. We're going to take a little bit more out of your paycheck. And then as an industry, we have to stand in front of employees and try to put lipstick on a pick. Hey, you have a more crappy plan and you're paying more out of it. Get excited. And it's somewhat embarrassing. I mean, I think literally as advisors, I think it's a battle cry for us to think of it. And that correlation is we have taught them that, well, blue Cross and Aetna, they say it's the same thing. And so we think it's the only channel is the same old thing. So they think that, so when you ask any cfo, ceo, HR and ask them, is healthcare a controllable expense? They will tell you no. And you hear things like a claim is a claim bush crap. A claim is not. I caught myself, I was pretty proud of myself. A claim is not a claim. I can an imaging a MRI at a hospital versus an an MRI at at one of her facilities. Completely D five times difference. So it is an education, it's an education that to the employer, it's an education to all advisors. It's an educated to a consumer that just like you shop for cars, you need to shop for healthcare. And until we accept that healthcare is a controllable expense and it can be shopped, that word consumerism is still going to mean, Hey, let's put $5,000 on a deductible and shove a little bit of money in an hsa.

Jessica Beames (08:08):

I think we have a really tough job too with the employers and consultants. We're trying to direct care and give them options on where to go, but we're compromising one of the highest trusted relationships that you have. I mean, patients meet with a physician within 30 minutes. They're comfortable with letting them cut them open. And we're trying to say, that person actually doesn't know what's best for you, or because they're not educated or they're incentivized to make a decision in the best interest of the facility they work with or for themselves because they're compensated too based on the referrals. And we all know that story. So that's an uphill battle. And we talk about benefits primarily once a year. I think every one of us here has probably said it's our Super Bowl, October, it's our Super Bowl, and we get really excited about it and then we don't really talk about it ever again. Or we plug in technology, which we heard about a moment ago. But that technology, how often are we really leveraging it throughout the year? How often are we touching those employees? And then the membership, because we all know spouses drive most utilization, are we reaching dependence as well at home? And so I think that communication and education is really challenging. And then also letting them know why you're making the decisions you're making. I have a lot of clients that at the beginning were really scared to tell their population they were self-funded and what that meant for them. But once they educated them on what that meant for them and their paychecks and the company's bottom line, they had buy-in. But that starts at the top. And so there has to be a cultural and philosophical alignment on your mission, on how you're addressing your health plan as well as how you're running your company. Why would you do that any differently? For a lot of my clients, it's a top two or three expense. I imagine it's the same for you and all of your clients. And so I think we have to change what we're doing as consultants and change the shift the perspective of the employers as well.

Alyssa Place (10:03):

And are any of you in that process right now? How have you changed to respond to some of these challenges?

Lester Morales (10:11):

I run a business that only does it. So, I've been in the business 22 years. I was the chief growth officer for one of the big box stores. And one day you wake up and you're like, this isn't fun anymore. Again, how do you go back with a straight face and be like, get excited. I just made 8% more of commission. I made a nice life. And at some point, I think it starts with a battle cry. It's a mission that once, I always say this, when you don't know, you can be ignorant once, it's all about what you do with it after. So for me, and again, I have a story of personal issues, so it, it's a little easier to do that. But I think if I could say anything for I, most of the folks in this room are advisors. It starts with us because what our clients call premium blue cross calls revenue. No one's going to get up in the morning and voluntarily lose their revenue. So it's not changing by that. The healthcare industry lobbies more than the oil and defense combined. So it's not going to be for the government. It's gotta start somewhere. And what do they say? Half of Americans get their healthcare through their employer and everybody in this room represents employers. I mean, it starts right here.

Alyssa Place (11:33):

And I mean, when you talked about some of that education and some of those challenges, I mean, I know the two of you work together. Can you talk a little bit about the relationship that you have and working directly with the healthcare provider to work on lowering those costs and making sure that it's quality instead of just the quantity?

Cristin Dickerson (11:53):

Well, and I think that's Lester and I run into each other 10 times a year at conferences. And many times many of the solutions are at these conferences. We're educating you all about what we offer. We're talk, collaborating. We help each other find clients. If somebody's doing something innovative, they're usually interested in another innovative solution. The thing again, that hospitals do really well is integrate. And what I'm really focused on is integrating with other solutions and with advisors. Now, if somebody brings me claims data, I can do a great claims data assessment, show what the savings are going to be if they offer the zero out of pocket. And I can hand you a PowerPoint that you can go take to that employer. And frequently we can be, or any other solution like us, is going to be the first step. We're bolted on alongside a Cigna plan here. This person can go show this and say, Hey, we can save you even if you do zero out of pocket, 30% on your imaging spend. And that really is a great first step. And then we start bringing in other solutions that we work well with. And I think we have to integrate. We can't do this. I can't do green imaging in a box. It's never going to work because I have to work with medical management. I have to work with a bundled surgery solution. All of these things have to work together. So that's really my focus. I have a mature product now. I have a mature network. My focus now is really integrating solutions and getting the word out and helping these guys sell it.

Alyssa Place (13:27):

And is that natural for your end to be working directly like that?

Lester Morales (13:33):

No, right? I mean, I think of my old brokers and is I was one, I am one. Whatever the word we want to say. So reality of it is we're protective over clients. So God forbid, don't call my client, don't tell 'em anything. So from a solution provider standpoint, the distribution channels through the advisor. So it's really interesting when you start thinking of it like that because you need the advisors to then carry the flag. I have, I always say this, I never have a bad meeting. No client ever says, oh, cost and quality, that's stupid. No, I want my employees to go bankrupt. You get out of the meeting, it's amazing. They've never heard of half of this stuff. Everyone's jacked up, you're high fiving. And then it's what happens when you leave that room, which is in the hands of the advisor and the client, and the client looks at the advisor and they advisor if it's their own client. It's really interesting to see the same advisor pitch something to a new client and the same advisor puts something to their own client. A new client's like Piss is amazing. You need to be doing this. Every innovative employer is doing this. Their old client, their existing client. This isn't around these parts of town. You need to be careful about that. So again, I think the conversation, if everybody looked at it on a piece of paper, we're all aligned or we should be, right? The reality of it is you can get somebody better healthcare for a cheaper cost, which is good for the employee, which is good for the employer. And if advisors woke up every morning doing what's good for their client and their employees, we would all be aligned.

Alyssa Place (15:07):

But?

Lester Morales (15:09):

I mean, it's a misaligned world, right? And a carrier makes more money when everybody spends more money, the hospital makes more money when everybody spends money, the whole system. It's not broken. It's completely designed incorrectly.

Alyssa Place (15:24):

So why don't we talk a little bit about solutions, get out of the doom and gloom. And I'd love to know Emma are I'm sorry, Jessica, what are some of the solutions that you're implementing right now that you feel excited about?

Jessica Beames (15:37):

Well, I love Direct Primary Care. It's worked exceptionally well for my client base, regardless of your size, the subscription model, you capitate your risk, it provides in most cases a white glove concierge care experience for the membership that you just can't get in a traditional carrier model. And even in a TPA model where you have a network and they're going to a health system or provider practice their access to care is increased, the quality of care they're getting is increased. And the P E P M and PMPM costs for the plans in which that is plugged in significantly goes down year over year. And the surveys we put out to the member population are just raving about the experience. They love it. And so what we're doing with our clients is we're continuing to narrow the options that the client employees have. Everyone still wants an HSA. I'm not a supporter of large deductibles. There is a reality that the tax savings is there and that it is a retirement vehicle. And so for some populations it does work and they like it, but it doesn't work for everybody. And so offering that second solution with a lower deductible, offering free solutions through direct primary care, and then allowing them to help navigate those members, do the options they have, whether it's through an imaging contract or a provider contract elsewhere, the trust is there that we talked about because it's their provider and they have a great experience. Also, I've been really surprised. I've had CFOs of health systems reach out to me to say, can we contract with your clients? Oh my gosh, yeah, let's talk about it. What's that look like? Because in the past it was they would do it and they were open to it, but I wouldn't say they were excited about it, their controller wasn't excited about it. But now there's more excitement in the self-funded employer space to contract. I think as consultants and employers, you have to be careful. But what that looks like, because not all services within the health system, as you've heard are the best. It doesn't always make sense. And so blanket contracts versus specific contracts, but those are the kind of things that I get really excited about. And you see work it, you see it in the claims data, and if you normalize it with utilization and population take out what does that per 1000 look like, how you analyze the data, all of that is important because numbers are tricky. And so understanding how to interpret them and then what to do with the information, I think is the challenge. But that's what I get excited about.

Lester Morales (18:11):

Do you wanna go?

Cristin Dickerson (18:11):

I can go, Green Imaging. We've widened the diagnostics we're offering, and this was at our client's request. Their members know how to use us. So we're offering colonoscopy and endoscopy. Cologuard I think is a great option right now. The genetic testing for colon cancer we're implementing a lot wider range of diagnostics. And that's been exciting. It's exciting for the members. They trust us. They know our concierge staff. So that's one thing we're doing. And then the other thing we're doing is what we're calling radiologist medical management at the core of green imaging, our physicians. And so we are getting involved actually when we see I, I'm a cancer specialist. When I diagnose a new cancer, I'm actually getting to the medical management team. And sometimes we're very closely aligned with the bundled surgery team and we're trying to at least notify that member and the members referring physician that they have a zero out-of-pocket option and try to get them to the high quality, lower cost option in their health plan. So that's one of the cool things we're doing right now. And that I see starting to bring things, make things more cohesive.

Lester Morales (19:18):

So I wanted to comment on what she said in regards to, I got asked on a podcast, what's been harder than you thought? And what's been easier than you thought? And what I feel has been easier than I would've ever thought is setting up direct contracts with facilities. It's math. How much does it cost you to chase money? So if everybody's never seen some of these stats, the average employee's got a three to $4,000 deductible in these days and age, that's five to $6,000 of out of pocket expense. The average employee doesn't have $400 in the bank. That math doesn't work. So what happens when that person goes to access healthcare, big healthcare, they've gotta lay down that money. They don't have that money that puts the hospital into a collection agency, 30 to 50 cents on the dollars typically what a hospital spends to chase that money. Okay, that's just math. If we can sit down in a room altogether and say, if you give me a 30 or 40 or 50% better reimbursement rate, I won't charge that person a dollar. We're done. There's a lot of details in the middle of it, but the concept of it makes complete sense and it's hard for anybody to argue. Now. It's about, again, people being confident enough to have that conversation, but also taking everybody's own perspective and only their profit margin out of the way. I just had a client on a webinar right before this, and we just did a direct contract for them. They have 300 employees, and if you take their average or their last claims, it's like at 162% of Medicare, I mean a 50% savings over the normal Blue Cross rate there. And it was because they said, Hey, if you do this, we will send everybody to you with no out of pocket. So that is something there. And I think one thing, obviously again, a very personal thing. My dad was on a drug called Revlimid. Revlimid is $150,000 a year. It has a patient assistance program, but nobody ever tells you about it. Okay? So I'm excited about how easy it is to save a client a crap load of money in prescription drugs. And when I say easy, nobody has to really do, I mean, one to 3% of the people are spending between 40 and 60% of the drugs cost one to 3%. So out of every hundred people, we're talking about a couple of people that might have to do something different in order to save that client 30 to 50 per, it's such a no-brainer. So if you're not leading with that as an advisor, if we're not having that conversation, that is the lowest hanging fruit of them all.

Jessica Beames (21:56):

ABe mindful of state legislation. You can no longer do that in the state of Oklahoma.

Lester Morales (22:03):

Still wanna do what?

Jessica Beames (22:05):

You cannot carve out specialty programs and leverage manufacturer co-pay assistance programs in the state of Oklahoma effective November 1st, 2022.

Alyssa Place (22:18):

I mean, in terms of when I wanna talk about data a little bit and how you're utilizing that. I mean, the numbers are there, the math is there. Why? How can employers and you guys really leverage that to make sure that you're presenting this stuff as fact and just numbers?

Cristin Dickerson (22:40):

Unbundling is a big problem. And what hospital systems do a great job of that? So for those of you who don't understand that concept, a 3D mammogram is actually billed out under four different C P T codes. There's the 3D code for the professional fee and the facility fee, and there's the screening or diagnostic code for both the facility and the professional fee. And so in order to compare that to a green imaging bundled price, I have to pull all four of those numbers out of the claims data and match them up and then average that and compare it to mine. I have yet to find an analytics program that does that. Right? And so the data is, like he said, it's intentional. The system is intentionally so complex that you can't compare apples to apples. So when you're comparing a hospital system direct contract to one from an imaging center down the street, you're not comparing apples to apples. And so that's one thing. I will go work with any analytics company and say, this is how you do this, right? Because I have TBAs all the time who compare me to Aetna, and it's just flat out wrong. And it goes out to brokers with comparisons with green imaging's name on it and it's wrong. So really getting educating, I think the advisors that this needs to be done properly. And then again, getting that to the CFO and letting them really look, I even have the biggest laboratory company in the country who I just did their claims data analysis. They had a $30,000 echocardiogram facility fee in their claims data. Somebody's not looking. And these are big, smart people that are running these health plans. So I think the more that we can educate both and providers know the game, we know it from how we get paid by health systems and by insurance companies, I think the more we can really try to get it to apples to apples. It is the key to this because they want it not to be apples to apples.

Alyssa Place (24:46):

And we just have a couple minutes left and I wanna make sure that the audience has something to really walk away with, a task that they can do or an action item that they could do tonight or tomorrow. I mean, in the immediate, what is your recommendation for the people sitting here today to kind of tackle some of the things we've discussed?

Jessica Beames (25:06):

Show of hands of those employer, well, I guess all the employers in the room. How many of you're self-funded? Just a few. And I'm assuming those who didn't raise your hand, you're fully insured. So if you're fully insured and you're over a hundred in most markets, you're going to get some kind of data. I would encourage you to take a look at that data use your consultant to see what the opportunities are to in a self-funded plan where you can save on the self-funded plans, you should be getting lots of data. And if you're using any of the solutions that we talked about or that you've probably heard about at this conference or just in the market in general, how are you measuring it? I think one thing we all do really well as consultants is we love to deliver these new shiny toys to our clients. Are you doing reference based pricing? Are you direct contracting? Are you using direct primary care? And a lot of it can be really reactive to the claims experience that you have and your plan. And so year over year, we're putting duct tape here and a little piece of paper here, and we're hoping that it fixes everything. And a lot of consultants that I find when I come in and take over the business is they've done a really great job of plugging in, bolting on and carving out and doing all the fun stuff, but they haven't measured anything. And so I come in like, well, it's great that you have this bundled service provider. How is that comparing to your direct contract pricing? We have no idea. Okay, well, what's your direct primary care vendor? What does that P E P M on your plan look like? We don't know. What's your utilization? Couldn't tell you. So you're putting all these solutions in place, but how are you aggregating all of that data to actually see what the impact is on your plan? Is it being meaningful? And so whether you leverage technology or your consultant is investing in technology, and if they haven't invested in some kind of data technology or partnered with the TPA or technology partner that can do that for you, they're doing you a disservice because it doesn't matter all the things that we've talked about, none of it matters if you can't look at it and actually quantify how it's impacting your plan.

Cristin Dickerson (27:16):

I would say walk the walk, get subscription-based primary care yourself. It's a game changer. You get a Sherpa through the healthcare system I do it. And every employee in my company's whole family has a subscription based primary care solution. And I think if you see it yourself, you come to understand how different healthcare is when incentives are aligned. And so that's my action item.

Lester Morales (27:47):

I think my term would be demand more. If you're an employer in this room if you think about the question, Hey, why do I like my advisor? If your first answer is They call me back fast or they're nice, you've got the wrong advisor. And it's funny, I talk to employers all over the place, Mike, why do you like your advisor? Well, we've had them for a long time. They're really nice to us. They're making a lot of money, right? And so the reality of what we have historically demanded of the industry is this is, it's quite pathetic. And so I just think asking the right questions, demanding more. And if that requires you to take a look at something else, then take a look at something else. Don't be afraid to give people to Jessica's point. Don't be afraid to give people data. I can't tell you how many times you'll have a conversation with a prospective client. You can prove it to them. I could prove how much she could save somebody. It's literally, you paid this. We could have paid this at the same place. They're four miles apart, so you could prove it. So data cures all four for the advisors. This business isn't easy. It's not easy doing it the easy way, right? Employers expect you to be a compliance expert, a communication expert, a VB expert of whatever. So this is not easy, but it's a hell of a lot more rewarding when you're actually being able to impact lives. And so I'd say one partner with the right people, it's get the right people in the room and have, this is not going to be one person saving the world. I think that that's the case. And a little tidbit about the data. We've always, we all talked about the data free consulting advice for every advisor and every employer. When you write an RFP for medical services or whatever in the RFP, write as a condition to win this bid. You must agree to give us this data on this frequency in this format. Do it while they're begging for the business. And when you finally now put that new solution in, now you can actually get the data in order to be able to do the analysis. But if you don't do it on the front end, you've already written the contract and then it's the tail wagging the dog when Blue Cross says, yep, we don't do that. And that happens all the time. So if you write it in into the RFP on the front end and it's part of the contractual language, then you start getting the ability to get the data.

Alyssa Place (30:22):

All right. Great. Well we're going to wrap up, so if anyone has any questions, you can catch us in the back. And thank you all so much for attending, and thank you to our panelists. Thanks.