Eric Silverman is one of the most disruptive forces in the area of “enhanced benefits”. You may have been calling them “voluntary” or “ancillary”, but Eric is passionate in his belief that neither of those words make the case for a benefit offering that is more important to clients and employees than ever before.

In this fast-paced interview, Eric explains how advisors interested in enhanced benefits fall into four distinct classes and delves into which group you want to be in for maximum productivity and client satisfaction. If you are currently active in this space or if you have been on the sidelines thinking about how to incorporate these solutions into your practice’s offerings, make sure to listen to this episode.

What You’ll Learn From this Episode:

  • Why language is important and the specific messages it sends when it comes to benefits.
  • What the four classes of advisors are as it pertains to enhanced benefits.
  • What two keys are for success.
  • If and when using professional enrollers is practical and advisable.
  • Why the current marketplace and today’s plan designs are driving enhanced benefits.

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Drug costs are soaring and driving more of medical spend than ever before. The good news is that there are tools coming to market to help consumers and plans alike.

That is what our guest, Gary Becker, CEO of ScriptSourcing and I discuss on this episode. We begin with an exploration of why prescription drugs are so much more expensive in the United States than they are in other countries. We discuss the particular drugs that are driving the pharma cost component to all time highs.

Gary explains the three strategies being employed by many plans and discusses how advisors can have this conversation with their clients. We conclude our conversation with Gary’s view that advisors must start charging for their services on a quantifiable, performance-based structure.

What You’ll Learn From this Episode:

  • Why drugs are so expensive in the USA.
  • How pharma is driving medical spend consistently higher.
  • The expected increases in pharma costs in the coming years.
  • What constitutes international pharmacy management.
  • How specialty meds fit into the pharmacy market.
  • The landscape of international pharmacy tourism and its effects on the pharma market in the US.
  • Whether advisors should bring this model to their employers, and whether they should get compensated on a percentage-of-savings basis.

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Should you enroll enhanced benefits yourself, or can a professional enroller help to create clear communication while maximizing enrollment and delivering better client satisfaction – and what are the financial considerations of that decision?

That is the question that Allison De Paoli discusses in this episode. Her firm, De Paoli Professional Services, specializes in becoming an extension of your office, enabling a more direct and in-depth communication about employees’ enhanced benefits in an effort to maximize participation.

We explore whether (in some situations) using benefits enrollment software makes more sense than doing in-person enrollments. Allison also explains that success in this practice area represents a combination of art and science – exactly the kind of nuance needed to help employees make the best choices for themselves and their families.

Finally, we discuss how some employers are making the choice of baking enhanced benefits into their plans, and what that means for advisors.

What You’ll Learn From this Episode:

  • Why you can’t simply use benefits enrollment software on its own.
  • What market sizes can benefit from professional enroller help.
  • Whether advisers should handle smaller cases themselves, or send someone from their office to manage them.
  • How much of enrollment is “art” and how much is “science”.
  • Why some employers are baking enhanced benefits into their plans.

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Episode Transcript:

David:     How can using professional enrollers help increase revenue and client satisfaction? We’ll find out on this episode of Shift Shapers.

Change either paralyzes, or energizes. The choice is yours. You’re listening to the ShiftShapers Podcast. You’re about to learn firsthand from businesses and entrepreneurs who have successfully shaped the shifts in their industries. Get ready to become the change that you want to see. Here’s your host and chief transformation strategist, David Saltzman.

David:      This episode of the Shift Shapers Podcast is brought to you by Captivated Health. A captive insurance arrangement, that helps small and mid-market companies escape the fully insured marketplace, and deliver stability, control, and savings, without watering down employee’s benefits, or increasing their premium share. If you have clients in the Educational Institution, or the Engineering Vertical, go to our website at captivatedhealth.com, or click on the company logo on the Shift Shapers website.

For a lot of really interesting reasons, there’s been a renewed interest in enhanced benefits, and there’s always the question when you talk to Benefit Advisors about that. About what the best way is to enroll folks to be both effective and efficient, and our guest today, Allison DePaoli, who’s the Founder and Benefit Enrollment Expert at DePaoli Professional Services, practices in this area, and has studied extensively, and we thought that Allison could help us answer some of those questions.

So, with that welcome Allison …

Allison:       Thank you, pleasure to be with you today.

David:        There are lots of Benefits Administration Systems, and some of them have pretty decent decision support tools, but you still counsel that one on one enrollment is best. Why is that?

Allison:       I do. One on one enrollment is best for a few reasons. First, it is still the crème de la crème of communication. There is nothing that beats a person sitting with another person to have a full explanation of their benefits. Today, forward thinking brokers are talking more and more about medical management, cost containments, scheme-e networks, RX discounts, where you go to get the best care. That is a lot for a C-Suite to absorb, let alone a regular employee. Even mid-level and senior level executives. Most people spend about 10 minutes a year on their benefits, and when you start to insert services like this, they do require a fair amount of communication, not just on a one on one basis, but in a variety of manners.

So decision making support, in an online benefits enrollment, an app on your phone that will help you find a provider, regular communication from HR, as well as the traditional group meeting. So, when you piece it together, one thing at a time, if you’re getting to six or seven forms of communication, you’ve fully addressed the communication needs of the group.

David:        So it’s not an either/or? It’s kind of more of an “All of the above?”

Allison:       I think it’s an “All of the above.” I worked for a gentleman who I just loved, who gave me the rule of 8’s, when I was teaching a group of people something new, and I’m not an overly patient person, and I was not allowed to express my impatience until I had explained something 8 times. Once I explained it 8 times, I could lose my patience. Rarely, did I get to 8 times.

So when you’re communicating in a variety of fashions, and over a period of time, people start to absorb what they need to do better, most people want to control their cost, they want the best care, they want to pay the least for their prescription drugs, they want to know what to do, when they need to do it, and they need to know how to piece everything together.

So, the more tools you give them, the easier it is for your employees to appreciate the benefits that you’ve worked on.

David:        That makes perfect sense, now are there certain market size segments that lend themselves more to one on one enrollment, as opposed to other methods?

Allison:       Traditionally, there has been a lot of public sector and large employer focusing on one on one enrollment. A lot of that has been product driven, sort of in the enhanced benefits arena. That is changing. With the advent of so many new tools, and so many different kinds of ways to piece your benefits package together, it is becoming a more holistic communication mechanism, so when we send a team, or when the industry standard now for sending a team is that they’re going to communicate all the benefits.

They’re going to get your medical questions answered, they’re going to refer where you need to go to find this piece of information, they have their own tools to make sure you understand how to use an app, or an advocacy line, or an RX discount plan. So, it’s much more holistic, and as that becomes more prevalent, you see more and more employers engaging in that service. So, used to be 1,000, maybe 500. Now you’re dropping that into the 500, the 200, the 50, and for small employers it’s always been more personal. Maybe you weren’t talking about a whole host of products, but if you have an employer with 20 or 25, or even 40 or 50 employees, and it’s been your case for a while, you know who those people are, and they’re going to come to you with questions.

David:        Would you recommend in that kind of situation that the Benefit Advisor do that enrollment themselves, rather than sending somebody from their office because they are so visible and so familiar to the case?

Allison:       I think that all Benefits need to be sold, not in an uncomfortable high pressure way, but I do think that they require some explanation, and sales education are very similar tools. You are explaining something to somebody so that they see the value in it. I think a professional salesperson is best suited to that, and I think it also allows that professional to see what is actually happening, and what people like, what they don’t like. If you don’t do that, there’s a lot of miscommunication, or misinformation, and you can solve a lot of problems in that sort of one on one environment, or a small group meeting environment, when it’s a small employer.

David:        So, if I understand you correctly, what you’re saying, especially in the smaller segments, is for advisors who are being asked to do more with less, who’s staffs maybe have gotten paired back a little bit because of commission compression, it’s critically important for them to do those one on one’s, because they will ultimately lessen the service burden of their office staff?

Allison:       I think it does lessen the burden of their service staff. It also gives them a pulse on what is happening, and I know it can be a little scary to do a one on one enrollment yourself, you can hybridize that, you can do some one on one, benefit platforms are getting more and more user friendly and useful for smaller case sizes, you can introduce that into your case as well. That is a great opportunity to grow the benefits package.

David:        Is this one on one enrollment, is it art or science, or some place in between?

Allison:       I think the technical aspects are science, but I think there’s a lot of art to it. I think it’s a sales process. The best sales processes are structure and personal delivery, and personal delivery is all art. I think it’s very important to know and to be able to read your audience as to what is important.

There’s a lot of research about the generational differences, and how people like to be communicated to. The reality is that the baby boomer generation, and the forgotten generation, as well as the millennials, they all want information, they just want to receive it differently. But when they want a question answered, they want a question answered by a person. They don’t necessarily talk to artificial intelligence or into a chat box, they want to talk to a person who can explain it fully.

David:        So, would you change your approach having the same conversation with a boomer vs a millennial, even though ultimately you’re going to deliver the same information?

Allison:       I think you should always tailor your communication to the person sitting in front of you. I think one of the big misconceptions is that older people and younger people have different risk tolerances. The millennial generation actually has a risk tolerance that is much more similar to the greatest generation, than to my generation.

David:        It’s interesting, because they’re also savers like the greatest generation.

Allison:       They are.

David:        As they’re becoming more and more part of the middle of that bell curve of the workforce, that’s becoming more and more apparent, and it’s fascinating that you make that connection as well, in terms of risk.

Allison:       Yes, they are very risk averse, for the most part. Not every person. They are also very interested in understanding what they have. I think it’s really important to explain it to them.

David:        Now, a word from our sponsor.

Captivated Health is a single source solution for your clients and prospects in the Education and Engineering Verticals. The Founders of Captivated Health have 35 years’ experience, working with healthcare and benefit clients. Over that time, they’ve developed a keen understanding of the unique problems mid-market clients experience.

Frustrated by a lack of control, the unpredictability of ever increasing healthcare costs, and the pressures and regulations of the Affordable Care Act, these groups have been adrift in the fully insured commercial market place, until now.

Captivated Health has built a program that solves those problems, and does so with virtually no disruption to employees, while saving clients millions of dollars. We wanted you to be among the first to know that Captivated Health is building a national distribution partner network, so you can bring this cutting edge solution to your education and engineering clients that you advise.

To learn more about Captivated Heath’s Solution, go to our website at www.captivatedhealth.com. Or click on our logo on the Shift Shapers website.

Now, the personal responsibility amounts on all of the plans that are being sold these days are going up. Is that driving a particular set of enhanced benefits, a particular set of products that you’re seeing more interest in, than we might have five years ago?

Allison:       Absolutely. Gap insurance is becoming more prevalent. It’s becoming more something that the employer might pay for, or there might be a cost sharing arrangement between the employer and the employee. That will help alleviate some of the out of pocket burden. Accident and critical illness are still the standards, and if you bake those into the planning process, so when you’re sitting down with your renewal, and you’re deciding how you’re going to manage for the next year, if you’ve got a good accident product, and a good critical illness product, you can eliminate risk for a significant number of medical events, and a good Gap or hospital indemnity plan depending on what your clients’ needs are, will help eliminate a little bit more of the risk.

It can be a real challenge to be a young family, and starting your family. You know, newly married, and starting your family, and your maximum out of pocket is $4500 if you want to have a child. That’s a pretty big hit. So, baking the Gap plan or the hospital indemnity plan into the coverage can help eliminate that.

David:        So, when you say baking in, is it kind of an opt out situation? Everyone is assumed that they’re going to get this? Or is it everybody gets it, whether you want it or not?

Allison:       I think it can be either. In some situations you want a Gap plan that’s baked in, and everybody who goes into the medical plan gets that, and then that needs to be discussed in your group meeting, and your one on one follow up, but it doesn’t have to be particularly for smaller employers.

What offering a Gap or hospital indemnity plan on a voluntary basis allows, is for the employer to have a little more flexibility to increase their deductible, or their out of pocket, and offer this alongside. I think it works best when those decisions are made when the plan designs are being reviewed, and the funding is being reviewed as well. Then you know how you can pivot, and how you can move, and to be truly effective, it’s helpful if you can watch that plan develop over 3 to 5 years, so don’t plan just for this year, plan for next year, and the year after, and 3 and 4 years down the road.

David:        Does the culture of a particular employer pay in to the decision of how those baked in benefits are offered?

Allison:       It absolutely does. Most employers really try to do the right thing by their employee. Employees are a valuable asset, and they really do try to do the right thing, and they may not understand how to both do the right thing for their employee, and do the right thing for their operating budget.

If you have all this on the table to start with, you have more flexibility in both situations.

David:        In your practice, do you find that, can you generalize?  Are there certain types of employers that tend to go one way vs certain types of employers who maybe tend to go in another direction?

Allison:       More forward thinking employers tend to look at a more holistic package, and employers and industries that are very competitive for talent look at more holistic benefit packages, and what they can add that will attract or retain an employee. Talent can be very difficult to keep, talented employees, you want to keep them. It costs 20% on the low end to replace an employee if they leave. It can be a substantially higher cost for a more high level employee, so you want to do what you can to retain them, and by enhancing your benefits package, you have an opportunity to do that.

The other thing that I’d like to point out, employees don’t necessarily expect an employer to pay for everything, or even to contribute to everything. Particularly with younger employees, they want to know how many dollars they have to spend, so more like a defined contribution, or defined contribution for this, you’re going to get that, and the other things they will participate in them or not, whatever it is that works best for their situation. Not everybody’s the same, but everybody wants a benefits package that works for them.

David:        Of course, and what I’ve started hearing, especially millennials, are keen on tailoring that for themselves. Would that be an accurate statement?

Allison:       Absolutely. Much more so, than older generations.

David:        So, is this like an awful lot of other employer based initiatives? Would it be fair to say that communication and education, even prior to enrollment, are really key in a commitment from the C-Suite?

Allison:       Commitment from the C-Suite is the most important indicator of success.

David:        Fascinating. So, if you’re talking to a Benefit Advisor, long before the enrollment happens, how do you counsel them? What’s that conversation like? What should they be talking to those C Level folks about?

Allison:       They should be talking about benefits packages as a capital expense, and not an operating expense. For the most part, employees are considered a capital expense, and not an operating expense, and benefits packages need to be managed. Every process in most businesses is managed. Everything you buy, everything you sell, has a purchase price, a value, everybody’s looking for how to reduce their costs. How can I buy it more effectively? How can I use it more effectively? How can I buy it more inexpensively?

By considering benefits to be a capital expense, you put some of that thought right into the process. You’re starting there. It’s not coming later. So you want your unit cost to be as low as possible, by considering it a capital expense, that is a C-Suite understanding of what that is. Oh, I should look at it as a business expense, how do I manage it?

David:        It’s fascinating that, back in the days when I was selling, it’s fascinating that employers will spend months evaluating a $200,000 piece of equipment, but they don’t want to spend more than more than an hour, talking about their $4,000,000 medical plan.

Allison:       Correct. That $4,000,000 medical plan, if it’s not being managed can probably be delivered for a significantly lower cost.

David:        Absolutely. So, back to advisors. Some advisors have a perception that using an Enrollment Firm, using Professional Enrollers is too costly, but if a one on one enroller is more productive, where is that cross over point, and where do they figure out where that line is?

Allison:       Traditionally, enhanced benefits have been used to fund a one on one enrollment. There are some costs, and there are some risks. You do need buy in from the C-Suite, there does need to be a commitment to making sure that every employee is communicated to on a one on one basis. So, there is some skin in the game for an employer. There’s some time, there’s some making sure people get through the enrollment, so the cross is, how effectively do you need your benefits to be used? How much do you value how your employee is using their benefits?

If an employee can feel more satisfied in their job, because they’ve had this experience, which realistically takes about 20 minutes per employee, and that increases your retention by 3%, 5%, 8%, what is that worth to you? What I think you’ll find is that, that cost, at one on one enrollment, is well under that in cost.

David:        One of the things that you’ve been nice enough to do is provide for Shift Shapers listeners, a link. If listeners click on the link to your logo, that’s on the left hand side of the Shift Shapers online page, or they look in the show notes there, you’ve made available a couple of calculators that will help advisors figure that out. Can you talk a little bit about those two different calculators, and why you use them, and how they help?

Allison:       Sure. There’s two calculators there as you said. One is for use if you are conducting your own enrollment, using enhanced benefits, some traditional products like accident or critical illness, that have a fair amount of heaped first year commission built in, and you can see what revenue you can drive, and that will help you determine how much expense you want to use when you’re doing your one on one enrollment.

The other calculator there is for if you’re using an enrollment partner, to help you with your enrollment. The commissions are lower if you’re using a partner, but those dollars are completely expense free. So, if you’re looking at increasing your revenue about 15 or 20%, that is revenue that will go directly to your bottom line.

If you prefer to do it yourself, there will be some costs. There will be some time out of the office, you will probably need an online enrollment platform, those are very cost effective and becoming a standard of business like good customer service. Whereas, five years ago that was a newfangled toy, and you might need some of your own staff out of the office for groups that are a little bit larger.

Your call. You may want to mix and match that up. You may find that with this group of employers, you want to use that yourself, so you’ll understand how much revenue you’re driving for yourself, and there may be other instances where you want to use a partner for that, and you’ll see how much the enrollment actually costs, because there is a commission split built into that, and you’ll see how much revenue you’ll drive directly to your bottom line.

David:        So, at the end of the day, it’s really a balance between being effective and being efficient, right?

Allison:       Correct. Isn’t it always?

David:        Well, Peter Drucker thought it was, but other folks not so much. You know, Benefits Advisors, one of the nice things that I think is happening, if you can say there’s a nice thing that’s happening from the commission compression that’s going on, and from being asked to do more with less, is that I think a lot of Benefits Advisors are really starting to look at their businesses as a business, rather than just going out and dropping product on folks.

I think ultimately, that’s a very good thing. But this notion of being effective and efficient, hasn’t always been part of the calculus of all Benefits Agencies, as you know, and today I think it’s more. I presume you’re seeing that as well in your discussions?

Allison:       I am seeing that in my discussions, and I think in every market there are some brokers that are more forward thinking, and thinking more like businesses, than about just running an insurance agency, which I agree with you, has often not run as a traditional business.

David:        So, we have about a minute or two left. We always like to wrap up our interviews by asking our subject matter experts, where do you see the future? What do you see happening with enhanced benefits, and then how firms such as yours, and other in the industry interact with Benefit Advisors?

Allison:       I think one of the most important things to understand about enrollments, is there are basically two parts. There is the project management. How do I execute, and deliver this project? You know, I need a timeline, I need materials, I need some structure, and then it’s a communication piece. How am I communicating to all of the different parties? Because there’s the C-Suite, the HR Suite, there’s an employee, there’s a management staff, there’s on the other end, there’s carriers, how am I getting this information back to carriers?

So, there’s a whole host of tools that you can play with. To me, that’s the interesting part. There’s apps now, where you can provide advocacy service, and you can provide access to medical management, to telehealth, to drug discounts, where is the most effective place for me to get my drug? My ID cards can be in there, you can do a text messaging campaign, “Hey everybody, wellness fair is next week, please come we’re going to make sure that your wellness benefits get filed.”

Those are all different kinds of tools, so the fun to me is integrating them all together.

David:        It looks like there’s going to be a lot more fun, as we get deeper and deeper into this world of enhanced benefits. It certainly has become something that for all the reasons we discussed, is becoming more prevalent, or there’s a resurgence I guess you might say, in that area. But a great place to leave our interview.

Allison DePaoli, Founder and Benefit Enrollment Expert at DePaoli Professional Services.

Allison, thank you so much for sharing your expertise with the Shift Shapers audience.

Allison:       Thank you for having me, it was a pleasure.

The Shift Shapers Podcast is a production of Strategic Vision Publishing and David Saltzman. This podcast may not be reproduced in any form, in whole or in part, without the express written permission of the producers. All rights reserved.

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We spend a lot of time and effort on enrollment, but how can we use the other 364 days to gain engagement and create health care consumers?  

That is the question Justin Holland, CEO and Founder of Healthjoy will help us explore on this episode of Shiftshapers. HDHP designs have shifted more of the financial burden to employees, but that shifts a great deal of the knowledge burden to them as well.  As always, the question is how to engage employees.

We discuss the addition of artificial intelligence via chatbots and other techniques such as push notifications and video offerings in addition to the more traditional concierge-type call-in model. Justin offers his experience with those techniques and tools and more, on this episode of the podcast.

What You’ll Learn From this Episode:

  • Strategies for educating and engaging employees after initial enrollment.
  • That consumers actually care about their healthcare options.
  • What role artificial intelligence and chatbots will play in personalizing the user experience.
  • Why quarterly newsletters and posters in the office are not delivering enough information.
  • Where telemedicine is going and how utilization will evolve for the average consumer.
  • Why push notifications can help create constant consumer engagement.

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Episode Transcript:

David:       How can service at the point of question help to create cost containment and provide benefit satisfaction? We’ll find out on this episode of ShiftShapers.

Change either paralyzes, or energizes. The choice is yours. You’re listening to the ShiftShapers Podcast. You’re about to learn firsthand from businesses and entrepreneurs who have successfully shaped the shifts in their industries. Get ready to become the change that you want to see. Here’s your host and chief transformation strategist, David Saltzman.

David:        On this episode of Shift Shapers we’re speaking with CEO and Founder or HealthJoy, Justin Holland. They’re doing an awful lot of interesting stuff in the employee engagement space and helping folks become consumers, and Justin’s done an incredible deep dive into this, knows more than pretty much anybody I know, and so we’re honored to have him on the program to talk about where this entire field is going. With that, welcome Justin.

Justin:        Yeah, great David. Thanks to you for having me on the show. I appreciate it.

David:        We appreciate you sharing your expertise with the audience. Let’s start at kind of an interesting level set. We spend an awful lot of time in our industry focused on enrollment, but that’s a day or two or a week. It leaves an awful lot of time where we’re not really doing a great job engaging consumers. What’s the opportunity there? Why is that space important?

Justin:        Yeah, so what we’ve seen, or at least what I’ve seen from the space, at least when I say that’s more from the venture side of the business, that a lot of basically venture money, private equity money, has been really focused on the bed administration, the enrollment side, of getting people in an insurance. So really focused really only on that 15 minute period of time when a person is trying to elect for their benefits for the year.

I think when we look at it, kind of the main reason for that was the advent of the ACA and Obamacare where we were just showing, “Hey, there’s this massive opportunity. You have 20 million people. They’re gonna be coming on board and sign up for insurance for the first time.” So it kind of made sense that there was a lot of focus on, “How can we get people actually enrolled in insurance?” I think what ended up happening was that they thought that it was kind of the same paradigm that the carriers had been working under for the last 40 years was, “Okay, well let’s just get people on insurance, and that should be enough for the year.” If they log on once a year into their portal on the carrier or the payer site, then that should be enough for them effectively to satisfy the need of the insurance carrier.

But what we saw was that as this paradigm shifts to these high-deductible health plans and more burden’s shifting to the employees, that one-time-a-year login wasn’t enough to actually make them utilize their plan in a successful way. So we saw this as an opportunity with this tectonic shift in the market to say, “Look, the consumer wants to be more involved with accessing their benefits.” They’re not on these $500 PPO plans anymore where they’re just signing up and effectively they don’t have to make a decision. All they had to do before was go to the doctor, and they’re effectively … they’ve hit their deductible, and then they’re just utilizing the care on their plan for the rest of the year.

But when you’re having to spend $2,000, $3,000, $4,000, or even more for the plan through the year, the consumer was just kind of left to their own devices. They were left in a desert to go navigate to find water and to go find shelter. So we saw this as a massive opportunity for us, and really for the industry, to come in and say, “Look, people actually care about using their plans. People actually want to be consumers, because this is the first time that they’re actually looking at their pocketbook and they’re trying to make a good decision across all these myriad set of opaque, different options that they had across the space.”

So we saw that as the opportunity of, “How can we be there? Those are the 364 days a year, where you may have spent only 15 minutes making that plan decision, and how can we really focus on hand-holding, be helpful, and attack all those different pillars of cost that go into utilizing healthcare in our country today?”

David:        Part of the tectonic change, to use your phrase, that’s happened is because of the increased personal responsibility amounts because of the advent of consumer direct plans; we’ve had trouble as an industry actually connecting employees to the cost of their healthcare. You know the old saw is that, “There’s a whole swap of folks who think that an office visit actually costs $20, or whatever their co-pay is.” If you don’t connect them to the cost of their healthcare, how can they become consumers and what do you do to get them connected? How do you get over that hurdle?

Justin:        Yeah. The first way is obviously shifting the burden to them, right? That was kind of step one. We look at the last 40 years of health planned design changes. Really it’s just been a continual movement towards, “How can we put this burden back onto the employee or the individual?” from a cost perspective. That’s step one, right? Step one, they have to feel the pain. If you don’t feel pain, it’s very hard to get any disruption in any space. That’s kind of the same for really any industry.

Now that they have the pain, they still feel lost. So they have to have tools. They have to have the services in order to actually become a consumer. They have to have … And that starts with transparency. It starts with access. It starts with good data across the board. Without those things, it makes it very, very difficult to actually be a consumer. If you’re … It’s like going to the grocery store and there’s no prices inside the grocery store. You might have access to the grocery store, but if you don’t know what stuff costs, it’s hard to make a decision across any of those.

I think that the pain is very clear. The pain is something that is talked about … From the media perspective and from a government perspective, we all know there’s a pain. I think that we’re just starting to see now in the last three to four years there’s a lot of new companies that have come up that are starting focus on, “How can we give tools so that people actually can be a consumer today?”

David:        But among all the bewildering stuff, we’ve given people tools for a while now. You know how it goes in open-enrollment meeting. If I’m an employee I’m focused on, “What are the plan changes that are happening this year? How much more am I gonna have to out of pocket, and how much is my premium going up?” I walk out of that meeting, and if I remember those three things I’m a superstar. So now the year goes on, I don’t remember all these tools and things that I have, and I have a healthcare event, or I need to encounter the system in some way. How do we help them get through that maze and get them back to the tools that they need and help explain how those operate?

Justin:        Yeah, that’s a good question. That comes down to education and engagement, right? If you’re not able to … This reminds of most of the carriers that we work with. They have great programs and services that can do a lot of these different things, but there’s a little consumer DNA to actually get people to understand and how to use those programs and services that they have. Being top of mind, making sure that you have your program or your service or your strategy, is constantly communicating to those people.

Because the issue is, healthcare is such a funny thing, where I’m selling you this basket of goods at the beginning of the year, and most likely you’re not in a situation where you’re actually utilizing care at that point, right? At the first of the year or mid-summer of whenever your enrollment period is. Then three months down the line, or six months down the line, or however far down into the year, you’re expected to remember that 30-minute webinar that you had with HR going over what your benefits were for the year. That’s just an unreasonable expectation, and that’s why it’s so important that it’s constantly communicating and constantly educating on those plan … on that program design that exists.

That’s really the only way that it happens. There’s no magic bullet. It has to be a constant set of, flow of data and information to the employee or the individual about what they have. Communicating through quarterly newsletters or office posters isn’t enough. It’s not gonna help just putting your nurse hotline poster on the fridge inside your company’s bathroom, or company’s kitchen. It’s just not enough. They have to be constantly aware of what they have. So when that time, let’s say 2:00 a.m., or if it’s they’re having a pregnancy, or whatever they’re going through, they need to really have it top of mind so that it’s present to them when they actually have to make that decision.

David:        And yet, in the rest of the consumer universe, we don’t keep stuff like that top of mind. I agree with you that education and communication are critically important during the course of the year, but with all the communication that we’ve been doing, if you look at … I think it was last year’s Kaiser Family Foundation study about healthcare literacy … most folks still can’t explain what a deductible or a co-pay or a max out-of-pocket is. So it’s 2:00 in the morning, and I’m having some kind of a health event, do I just pull an app out of my pocket and call some kind of advocacy system? The reason is ask is, there have phone based advocacy systems now for a long time, and sometimes they’re more sophisticated than others, and sometimes they’re just interactive voice response systems. How do I handle that at point of pain?

Justin:        Yeah, no. That’s kind of the big thing that we see, is that the advocacy services today, many of them, are really focused on in-bound engagement. They’re really expecting you to remember once you have the … After that one enrollment you’ve had, they’re expecting to take their, that card, or maybe that phone number that they had in that benefits packet, and you’re supposed remember that you actually can go back there and actually use it. I think that what we see, to answer your question, I say, “Yes.” We see that ideally you are going back to this application, or an application or some other service where you’ve been constantly reminded to return to. So that when it is 2:00 a.m. you are top of mind, and the …

That’s really the challenge. The challenge in the space is really on the engagement side of, “How do we get people back into an experience consistently?” Whether that’s through a wellness narrative, whether that’s through HR or wellness communication, whatever that is. But the thought that if you’re gonna give someone a card or someone a phone number and expect them to be able to use that when they actually really need it, it’s kind of unreasonable.

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David:        A lot of the phone-based advocacy systems are getting some pick up from employees, but they’re not getting the kind of engagement that I think all of us would’ve wished. I know there are some new technologies that are being employed, some version or some form of artificial intelligence, chatbots. Would you talk about those two things in particular, and how those might increase employee engagement and employee comfort?

Justin:        Yes, and I think it goes back to my last comment on the idea of personalization to the user. There’s really no way to do that without a, really an AI, that can actually synthesize that data, understand the most applicable time to reach out to a consumer. We use a chatbot in order to make it a really comfortable interface for members. Where at this point, luckily Siri, Cortana, Google Now, have kind of made the concept, and Alexa, have made the concept of talking to your device something that’s very, very normal, where 50% of the country has actually talked to their phone. Which is kind of a funny concept, talking to the phone and expecting it to answer back to them with the correct answer.

So what we see is that really the only to scale a service in a way where you can have a multitude of outbound communication across the entire day and across the lifetime of the user, and understand the exact time to interact, artificial intelligence is really what has enabled us to be able to do that. In cases where the AI is not able to answer those questions, or able to actually satisfy the need, then it’s able to connect to advocates, or a concierge, or nurses, or even in case doctors, in order to address needs when those comes in. So your example of 2:00 a.m. at night, ideally you’re talking with the AI, and then the AI is able to triage you effectively somewhat similar to a healthcare professional, to appropriate level of care. Ideally, that’s just an advocate, but in some cases it could be a doctor.

David:        I know one of the other things that you’ve done an awful lot of research on is another tool that seems to have great promise, but isn’t really delivering on the level of employee engagement that one might think it is, and that’s telemedicine. Where’s that going and how is that going to improve so that we do get that kind of throughput that we need?

Justin:        Yeah, so there’s two really main things that affect the utilization of telemedicine. The first one’s regulations, so making it easier and more accessible to members and having a wider range of scope of services. Telemedicine started off with a very narrow set of services that it could handle. Now there’s the services started to include behavioral health, specialists, HIPPA is starting to get involved. There’s second opinion options, and that kind of scope of services has expanded.

So what we see is the main problem with telemedicine is that people don’t really understand what that scope of services is. When you’re talking, it’s 2:00 a.m. and your two-year-old has a fever and you’re freaking out, you’re first inclination is, “Well, telemedicine could never satisfy this need.” And it can, and so I think that’s where we see having a comprehensive solution up front where you’re saying, “Hey, come for anything. Any question you have, whether …” However, obviously if it’s an emergency situation you should go to the ER directly, but if it’s a level below that how can we educate you in that process to understand that telemedicine is something applicable?

I think that’s the main thing that we have seen is that people really don’t understand. If you think of the funnel of a lot of these carriers are putting out their own telemedicine programs, for someone to remember to go to the carrier site that they go to once a year, which is hard enough. Then finding it on their site, which is buried. Then understanding that, “Hey, I have specific need that this is actually gonna satisfy,” and then going through process is very, very low. So what we see is, and we get excited about is, “How can we steer you from a need that you might not understand that is working with telemedicine?” So if you come and you say, “Hey, I have this weird abrasion on my skin. I need to see a dermatologist.” We say, “Well, wait a second. This is something that’s applicable to telemedicine.”

I think that’s where we’ll see the industry moving, is that these services will be focused more on, “How can we direct you to these lower cost of care?” Sometimes telemedicine won’t be the answer, right? Sometimes it’ll be retail clinics. Sometimes it’ll be urgent care. In some rare cases it’ll be ER. But really the point is, is that people don’t understand really what the scope is today. It is only going to improve, and then as those regulations change and it’s wider and wider scope of service, then it’ll become more of a commonplace and every day care for people in the country.

David:        Justin, in the few minutes that we have left, I’d like to cover something that we haven’t talked about, because we’ve taken this all from the employee’s aspect, the employee’s standpoint. But at the end of the day, risk management is critically important, and mitigating costs trickles into the employer. What kind of an impact can more robust services like this, that help employees engage, have on an employer’s bottom line?

Justin:        Oh yeah, no absolutely. It’s all about cost containment.

David:        Yeah, the-

Justin:        I guess there’s … It’s more than just cost containment, it’s also benefit satisfaction, which it’s … That’s also a level for the understanding that HR has spent a lot of time, along with the benefit consultants, organizing these plans for their employees. You really want people to use everything that you have put together for these plans. So making sure that utilization, not just for telemedicine, or the nurse advocacy, or for your accidental, or your life insurance, or whatever it is, is being used, but really that that’s all understood. Then making sure that that program is focused on attacking the pillars across the landscape is important.

If you’re looking at a program and they’re not talking about, “Hey, this is going to cost you less in claims per year, and it’s going to cost you less in claims by the amount of cost of the program,” that has to be part of the conversation. If it’s not really a 30-day ROI, then it’s probably not a program that’s gonna work well. I mean, there’s plenty of different strategies across the … across prescriptions, across procedures, across the diagnostics, there’s a lot of great services and programs and things that exist that allow us to focus on, “How can we really mitigate cost? How can we get in front of these different pillars and really make an impact?”

We get excited when integrated with TPAs, and being able to understand at-risk populations. Being able to outbound against those populations and make sure that, “How can we be more involved in their chronic management of their diseases?” So it’s really about cost and satisfaction. I think that depending upon where certain companies are, it’s really a different need for the different companies in the life cycle that they’re looking at.

David:        In the minute that we have left, we always like to wrap up where we can by asking the question, “Where do you see the future?” Where do you see all of this technology and all of this interaction going? What’s your vision?

Justin:        Yeah. The way I see it is that healthcare should be just like Siri, right? With correct answers, which sometimes Siri today doesn’t do that well of a job, or Alexa.

David:        I’m glad you added that.

Justin:        Yeah. I think that in 10 years, I like to think that … I think what’s so difficult about health in general, is that there’s a lot people in the space that can look at individual aspects of cost, or individual aspects of care, and they say, “Hey, I have a solution that’s gonna work well with this.” But they don’t take in account plan design, and they don’t in account the broker relationship, and HR, and understanding, “How can fit this into wellness programs? How can I synthesize all this different data and make it applicable to this individual or employee?”

I see that’s where the power of machine learning and AI over the next 10 years is going to allow us to synthesize more and more of this data at point of care, or really at point of question, and get you something that’s incredibly compelling from a decision point of view. I see that that’s where we’ll be, and from a regulation perspective and how things move, we see more and more burden shifting to employees. We know HSAs will be big next year, so that’s just more indicative that, “Hey, there’s probably gonna be more and more focus on the employees to be more responsible for pay.”

So there’s gonna be further and further consumerism across the space. So we’re really excited about the future. We think that putting the decision to the consumers, right where it needs to be, because we’ll have to break down the walls of opacity. I think that we’re gonna have a very, very transparent healthcare world within 5 to 10 years, and I think we’re all really excited about that.

David:        That’s a great vision, and something that I think of us have been looking for for quite some time. Justin Holland, CEO and Founder of HealthJoy. Again Justin, thank you for sharing your expertise with the Shift Shapers audience.

Justin:        Yeah, great. David, thank you so much. Appreciate it.

The ShiftShapers Podcast is a production of Strategic Vision Publishing and David Saltzman. This podcast may not be reproduced in any form, in whole or in part, without the express written permission of the producers. All rights reserved.

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Al Lewis, our guest on this episode of The ShiftShapers Podcast, is a serial entrepreneur, author, renaissance man, and the CEO of Quizzify. Quizzify is a healthcare education app that uses fun and games to teach employees how to buy and use healthcare. The service makes for smarter consumers and saves their companies a lot of money in healthcare costs.

In this interview Al shares his interesting journey, beginning with his time at Harvard Law School and culminating in the creation of Quizzify. We discuss current healthcare literacy issues, how to get employees excited about learning, and Al’s unique approach to solving these problems. We also cover how Quizzify integrates with a company’s wellness program and what employer conversations about healthcare and education look like.

What You’ll Learn From this Episode:

  • How got Al credited with inventing Disease Management.
  • What it will take to increase health care literacy.
  • How to engage employees in learning more.
  • The crucial difference between wellness and wellbeing.
  • The risks of doing too many CAT scans.

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The story of our industry over the last decade has been one of mergers and acquisitions. The ACA has propelled new levels of activity as benefit advisors are leaving the industry and selling their practices. This episode’s guest is in the middle of the action, and here to share his expertise and opinions on the advantages some firms have found by becoming part of a larger organization.

Brett Rosen is the Executive Vice President of Mergers & Acquisitions at One Digital, formerly Digital Benefit Advisors. In this interview, we discuss the most important things driving the M&A wave and how advisors are finding opportunities to join forces with other practices to create new practice models that deliver incredible value to their clients.

Later, we lay out the steps that agencies and their owners can take to prepare for merging, and why being acquired might be a good future strategy. Equally important, we also consider the view of larger firms and what they consider when they are buying another business.

What You’ll Learn From this Episode:

  • What is driving the recent uptick in M&A activity.
  • How PPACA has impacted the process.
  • The advantages that come along with a merger.
  • What agencies can do right now to prepare for a future merger or acquisition.
  • What purchasers look for when buying a practice.

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The move from “wellness” to “wellbeing” requires a more holistic approach which includes helping employees become financially well. Understanding the need and bringing the right technology to employers can help advisors expand their offerings and differentiate themselves.

Chris Whitlow of Edu(k)ate joins us to talk about the need, the approaches and how technology and unbiased financial advice are helping companies support all of their employees with these essential skills regardless of financial status.

Technology, data collection, and actionable information enable companies to provide scalable solutions for helping their employees feel more confident with their money. Encouraging financial wellness and literacy in the workplace allows employees to take care of their finances out of the office and feel confident when making impactful financial decisions. 

In this interview, we begin by defining financial wellness and identifying some of the common obstacles that prevent employees from achieving it. We also discuss why this holistic approach to employee engagement is essential for productivity, and why your clients should foster a corporate culture that makes it safe to ask questions about something as integral to daily life as money.

What You’ll Learn From this Episode:

  • The new definition of financial wellness clients are adopting.
  • Why the scale and need for financial guidance demands new approaches.
  • Why traditional resources for financial advice are no longer enough to help employees make good financial decisions.
  • The challenges employees and employers face due to a lack of individualized financial guidance. 
  • How technology is changing to help meet the need for unbiased financial advice.
  • How employers can drive engagement.

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Transparency is the single topic with the most potential to transform every aspect of health and health insurance. We’ve decided to devote two episodes to this potentially innovative topic.

For part one our guest is Ralph Weber, President and CEO of MediBid. Ralph is a passionate subject matter expert and serves as a member of NAHU’s Healthcare Cost and Quality Transparency Workgroup. In this interview, we explore his belief that current healthcare pricing schemes purposefully withhold information from consumers, and why Millennials in particular won’t accept the current status quo on transparency (or lack thereof).

Ralph also describes the effects transparency has on the U.S. healthcare system, the marketplace, and the competitive environment. He shares why transparency alone won’t affect the needed changes to our healthcare system. We also learn why some hospitals charge more for the same type of treatment than others as we discuss the differences between static and dynamic pricing.

What You’ll Learn From this Episode:

  • Ralph’s journey in the health insurance space.
  • The difference between dynamic and static pricing and its effect on the consumer.
  • How Ralph defines transparency.
  • Whether or not the most expensive care is the best healthcare.
  • What the future of transparent pricing and healthcare services might look like.

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Many of the precepts on which health reform efforts are based are nothing more than myths. ShiftShapers guest Greg Scandlen explodes 30 of those myths and why those incorrect assumptions continually doom efforts at health care reform. 

Based on flawed research, incorrect assumptions and flimsy evidence, these myths may make great bumper stickers but they yield miserably screwed up health care policy. Greg’s new book, Myth Busters: Why Health Reform Always Goes Away explores those false assumptions. From Roemer’s Law more than 50 years ago to the “crisis of the uninsured” to small group reform in the ’90s and today’s “reform” discussions, our guest believes that it was inevitable that we find ourselves in such a mess.

Greg discusses how academics in government agencies stir up fake crises and issue ineffective resolutions. He also digs into the oft-repeated idea that greedy doctors are the problem and other common yet flawed assumptions about healthcare. Listen in and get your myths busted!

What You’ll Learn From this Episode:

  • Why Greg decided to write Myth Busters for the current healthcare and political climate.
  • The people taking money out of the healthcare system.
  • How Roemer’s Law started the slide in healthcare policy.
  • How Medicare changed everything and skewed incentives.
  • What academics get wrong when reforming health care.
  • Why hysteria over the uninsured is misplaced, and crises are often overblown.
  • Little known facts about the “Insurance Crisis”.

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ShiftShapersCoverArtThis week on ShiftShapers, Kevin Trokey joins us to share strategies for building a market-competitive insurance agency. Kevin is a founding partner and coach at Q4Intelligence, a consulting firm dedicated to removing the barriers that keep independent benefits and insurance agencies from reaching their full potential.

Kevin reveals how his extensive experience as a broker and a principal helped him develop the firm’s unique approach.  Kevin talks about a common mistake most agencies make: focusing their marketing on their own story, rather than that of the consumer. Consumers aren’t looking for you to look exactly like every other provider out there; they want to know which agency can creatively and efficiently help them solve their problems.

Kevin discusses importance of agencies becoming more competitive by realizing their true purpose – helping business owners achieve what they really want. He also addresses the role of increased employee engagement and improved collaboration between the service and sales parts of business in boosting overall agency success.

 

What You’ll Learn From this Episode:

  • How Kevin’s extensive experience as an agency principal helped him to develop his transformational methodology.
  • Why the traditional website design of agencies can off-putting for consumers looking for a solution.
  • The often self-imposed barriers that keep agencies from taking control of their business.
  • The benefits of separating the product and consultative stages of the process.
  • The necessity of building community amongst agencies.

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