• John DiMartino

Your Broker is Retired

Updated: May 11


He or she just hasn't told you yet.

In a time before the double digit inflation of the 2000's, the life of a benefits broker was simple. Meet with your client once per year to discuss the renewal, note that the renewal increase was 5% or below, advise them to accept the increase, fill out the paperwork, and move on to the next one.

At the very most, a benefits broker would "shop" the plan to other insurance companies to see if they could get a better rate. If they could get a better deal, great! They were happy, the client was happy, and although employees didn't want to change vendors, at least their out of pocket expenses were kept relatively the same. Great coverage, relatively affordable price.

Then things began to change....

Renewal increases started to get larger and larger. Employers began to see 5% turn into 10%. 10% then became 15%, and so on. When the ACA really became live in 2014, I was aware of a fully insured group that received a 120% increase. Absolutely insane.

So what was the proposed fix for this increase in medical/rx costs?

The easiest way to go was to simply ask workers to pay more towards the cost of the insurance. Employers didn't want to increase deductibles or coinsurance, so they increased premium contributions.

When that didn't stop medical inflation from increasing year over year - it was time to shift costs to the employees. By increasing the copays, deductibles, and coinsurance, the employer could offset these large renewals. This didn't stop costs from increasing year over year and it made seeking care very difficult for employees.

THE RISE OF THE ADVISOR


The issues faced by the American people and the employers that provide their healthcare have gotten exponentially worse. The brokers that have overseen your plan for 10 or more years have failed to provide you with any solutions that actually bend the cost curve. Your broker has seen their commission increase every year and you have been left holding the bag.

Liberty Benefit Advisors is part of a new wave of benefits consultants that lower costs by improving health benefits. Here are a few of the ways this new wave of consultants is challenging the status quo.

VALUE BASED PRIMARY CARE


Status Quo

  • Flawed reimbursement incentive have turned primary care into "loss leaders" like low margin product designed to get people to high margin items

  • Short Appointments due to not investing properly in primary care

  • Primary care shortage due to making primary care discipline unappealing

  • Long wait times to get in can lead to small "fires" blowing up

  • Medically unnecessary face-to-face encounters

  • Record levels of dissatisfaction & burnout amongst PCPs

New Wave of Consultants

  • High Net Promoter Scores

  • Ounce of prevention is worth a pound of cure

  • Same or next day appointments for issues not addressed via email/phone

  • Extensivist has smaller panel allowing proactive care management & coordination

  • Can reduce issues 40%-90% and spend 20% - 50%

  • 24/7 access via telemedicine service


ACCESS TO WORLD CLASS ACUTE CARE HOSPITALS FOR COMPLEX, EXPENSIVE PROCEDURES

Note: 6% of employees at large organizations typically account for 80% of medical costs.

Status Quo

  • Quality and prices vary widely

  • Studies find 40% of transplants are medically unnecessary

  • High rates of complications at community hospitals who don't do high volumes of complex procedures

New Wave of Consultants

  • Access to high quality, low cost surgeries nationwide

  • Access to cost transparency data and pre-negotiated rates

  • Second opinions at no charge for employee at centers of excellence

  • Unit cost often higher, but lower complication rates & avoidance of unnecessary procedures present ROI


RETIREMENT HEALTHCARE COSTS

Status Quo

  • With pensions mostly gone or severely underfunded, a very low percentage of Americans have healthcare savings for living or health costs (estimated $300k per household not covered by Medicare)

New Wave of Consultants

  • By avoiding wasted costs, companies are able to fund HSAs, 401ks, and pension plans


COORDINATED CARE

Status Quo

Can be fragmented in two situations leading to preventable errors:

  • When a person is receiving care from two providers, especially when that care exists in different places at different times and

  • During transitions of care when one provider takes over from another

Examples include a patient seeing several specialist as well as a primary care physician; A patient transitioning from hospital to home, hospital to skilled nursing facility or to a hospital offering a higher level of care.

New Wave of Consultants

  • Providers coordinate care by asynchronous communication facilitated by electronic health record systems, either by sharing the same system or though a health information exchange.

  • Providers utilize HIE for direct, secure communications between primary care and speciality care, which can reduce unnecessary in-person consultations.

  • Provider provide warm handoffs during transition of care, up to and including POTS dialog when appropriate. Providers commit to thorough and timely documentation, especially for discharge and transfer summaries.

  • Providers and specialist develop treatment compacts that avoid duplicative testing and treatment or conflict.

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