The-Shift-Shapers-Podcast-(Rough-Comp-2)On this episode of ShiftShapers, we’re pleased to welcome Sally Poblete, the CEO of Wellthie, to discuss how consumer expectations are influencing technology trends in the health care industry. Since everyone from millennials to baby boomers is eagerly adopting tech tools and mobile devices to manage their daily affairs, it stands to reason that consumers would gravitate toward tools that simplify their health care decision-making process.

Sally shares why she believes the eCommerce movement in health care upon us. Benefit advisors who embrace technology can play an integral role helping their clients make the best decisions. She provides tips for advisors looking for obvious starting points to incorporate technology as they seek to connect with a broader audience.

A recent study found that only 14% of consumers are proficient regarding their ability to make health care decisions. Useful software tools are being developed. Savvy advisors will position themselves to help consumers bridge the knowledge gap. Sally shares what advisors should know and how they can adequately prepare to address that need.

What You’ll Learn From this Episode:

  • Sally’s background and how that lead to her current career.
  • An explanation of the retailization of health care markets.
  • How benefit advisors can encourage health care engagement vs avoidance.
  • The level of health care knowledge within the general population.
  • The transition away from spreadsheets as advisors embrace technology to better serve clients.
  • How millennial consumer behavior will impact health care decision-making trends.

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This week on ShiftShapers, Paul Gable, President of IBX, lends his expertise on technology tools in the benefits industry to the discussion. Benefits advisors are being challenged to meet the demand of delivering a higher quality of service with more efficiency to remain profitable. Paul highlights the affordable resources available to help small and mid-sized agencies recapture efficiencies in their businesses and thus save money.

Paul points out that most agencies waste time with inefficient processes. Two-thirds of an advisor’s time is routinely consumed with non-client facing or back-office administrative duties. When these processes are restructured, advisors can spend more time with clients.

The cost of basic customer relationship management tools available can be financed in a variety of ways that make them affordable for a wide range of agencies – regardless of size. Paul highlights how advisors can best take advantage of the off-the-shelf products available and what you need to know to evaluate potential vendors.

What You’ll Learn From this Episode:

  • Why advisors need to create operational efficiencies.
  • The percentage of an advisor’s time that is actually spent selling.
  • The steps needed to creating effectiveness at lower cost and with a higher return.
  • What a CRM is and how it differs from an Agency Management System.
  • The opportunities to automate the RFP process in a way that delivers higher sales percentages.

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This week on ShiftShapers, we wrap up our two-part discussion with Brooks Goodison, President of Diversified Group.  Last week, Brooks helped us sort through the changes underway that target groups that want to move away from fully-insured plans. This week, he highlights strategies that employer groups are using to fight the rising cost of health care as a result of the Affordable Care Act.

Health care expenses can easily become one of the largest expenses for families and the rising costs have a direct impact on a consumer’s ability to plan for their financial future. Given this reality, employers are actively looking for ways to control health care costs. Brooks points out the pros and cons of reference-based pricing and provides case studies on how these programs compare to traditional PPO contacts.

He also clarifies whether allowing consumers to purchase health care across state lines will produce tangible savings. Is this just an election year talking point or can this strategy actually bring down costs without sacrificing health care quality?

What You’ll Learn From this Episode:

  • An introduction to reference-based pricing.
  • How widespread reference-based pricing is today and whether it will gain traction.
  • Whether reference-based pricing could fundamentally change our notion of “networks”.
  • Why politicians keep talking about selling across state lines.
  • The new techniques and challenges with employee engagement.

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A quiet battle at the state level may make it more difficult for you to be creative in the small and mid-market spaces.

In this week’s episode, Brooks Goodison, President of Diversified Group joins us to discuss how renewed interest in partially self-insured plans in the small to mid-market has drawn the attention of state regulators. In this first segment of a two-part discussion on ShiftShapers, Brooks helps us sort through the changes underway that target groups that want to move away from fully-insured plans.

New York, Maryland, Connecticut and other state regulators are changing stop-loss insurance regulations in ways that would severely impact the number of employers able to take advantage of partial self-insurance options. Some believe that these regulatory moves are nothing more than an attempt to force membership into state exchanges. Others believe that only large and jumbo groups should be permitted to partially self-insure.

Employers looking for strategies to move the needle on healthcare costs will find this discussion valuable. The ACA and other external pressures are forcing groups to look carefully at all options. This episode highlights technology that can help employers with better decision making and control cost without sacrificing health care quality for employees.

 

What You’ll Learn From this Episode:

  • Why the renewed interest in self-funding is drawing the states’ attention.
  • How the general election is apt to affect this incursion.
  • What private exchanges are and whether they are a new panacea.
  • The latest strategies and tactics to move the needle on costs.
  • How TPA can become a strategic partner with an advisor generalist.

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This week, we welcome Patrick Irving, Managing Director of Covala Group, to The ShiftShapers podcast to help us explore the overlooked opportunities available with disability income. With only 30% of Fortune 1000 companies (and fewer in other segments) providing coverage in this area, advisors willing to develop a DI expertise will be in a prime position to expand their practices while providing invaluable coverage for their clients – often at a discount!

This episode is packed with useful information for benefit advisors: Patrick clarifies some of the DI terminology that can often be confusing.  He goes into detail about the taxation of DI benefits so advisors can better serve their clients while saving them money. He also tackles the classic chicken or the egg question regarding whether Group or Individual coverage is the best first option.

Advisors dealing with commission compression or looking for additional revenue streams will definitely want to leverage the opportunities available in DI coverage and you should begin with this episode. Patrick provides a wealth of information and specifics on how to help your clients seamlessly integrate DI benefits into their existing plans.

What You’ll Learn From this Episode:

  • The market opportunity available with disability income.
  • The difference between multi-life, group, GSI and individual plans.
  • An expert perspective on whether an Individual or Group plan should be purchased first.
  • Why it is important to understand the taxation of disability.
  • Which items are generally not covered by Group DI.

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In part 2 of our quarterly visit with Jessica Waltman, we explore the upcoming regulatory changes during this election season that will directly affect benefit advisors.

Jessica is a Principal at Forward Health Consulting and is a regular contributor to ShiftShapers.  As one of the preeminent experts on how legislative and regulatory changes will impact your practice, she is the perfect guest to help advisors sort through the flurry of new rules and focus in on what’s most important.

Regulatory changes are emerging at a fast and furious pace as we near the end of President Obama’s second term, and not all of those changes are directly related to the Affordable Care Act. Jessica describes in detail how these new changes will impact health plans, retirement plans, and health reform requirements. Anyone who sells group insurance will be impacted by these proposed changes.

Additionally, advisors need to be able to communicate quickly and clearly to their employer clients who can face fines and additional documentation requirements once the expansion is finalized. Advisors who understand this new environment will be better positioned to help their clients navigate the changes successfully.

Jessica shares the latest information on everything from the increase in fines and penalties or changes to wellness program requirements.

What You’ll Learn From this Episode:

  • How the proposed expansion of Form 5500 will impact health care plans.
  • What the confounding compliance complexities are.
  • How implementing the EEOC Wellness Rules will impact plans.
  • What the potential snags and pitfalls are in Employer Mandate implementation.

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In part 1 of our quarterly visit with Jessica Waltman we explore the “public option”, which down-ballot elections you should be watching and more.

Jessica is Principal at Forward Health Consulting and is a regular contributor to ShiftShapers and one of the preeminent experts in how legislative and regulatory changes will affect your practice – and your clients. While we are all focused on the race for president, there is a much broader canvas to watch as well.

There has been renewed discussion of “The Public Option”, but Jessica points out that there are differing notions of exactly what that means, and different ways in which it might (or might not) get implemented. Essentially, the public option is a government-run health care program set up to compete with private insurers. Some say it’s the only way to save the Affordable Care Act since insurers are pulling out of the individual exchanges. Is it? We ask Jessica for insight.

Rising health care rates, a lack of competition, and disappearing co-ops are also creating a great deal of noise in our markets. The Risk adjustment mechanism under PPACA continues to drive perverse incentives and we explore some of the thinking around how those might be fixed.

Advisors who understand how the legislative changes impact both the group and individual markets will be better positioned to serve their clients.  Jessica helps to clarify the potential changes on the horizon. In next week’s episode, we dig into more detail on a number of the recent regulatory changes and explore those that (may) come. Stay tuned!

What You’ll Learn From this Episode:

  • Why there is a renewed interest in the public option.
  • Which down-ballot races we should be watching and why.
  • What the impact of rising rates and lack of individual market competitions are on your practice.
  • How to fix the “Risk Adjustment” mechanism in PPACA.

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Technology is most useful when provides insights that help you advise your clients on changes they can make to lower claims costs and bend their trend.

Our subject matter expert this week is Keith Lemer, CEO of Wellnet Healthcare Plan and a founding member of the Healthcare Performance Management Institute – a think tank focused on using technology to bring down the cost of health care.

Regardless of a company’s size, without measurable data – process improvement is difficult at best.We invited Keith to discuss how advisors can access relevant data to improve the decision-making processes.

With data, advisors are in a prime position to help their clients make choices that will reduce health care costs, increase compliance, and better control health care dollars spent.

Once identified, we explore strategies for working with the 20% of the population that is driving the majority of claims costs. We also discuss the top three issues advisors face, and what tools are available for them to use. Health insurance is expensive because health care is expensive. Since that shows no sign of abating, clients will be looking to advisors for expert guidance on innovation, expert delivery, and how to  reduce costs while achieving the best quality and outcomes for employees.

What You’ll Learn From this Episode:

  • How the Healthcare Performance Management Institute was formed.
  • What resources are available to advisors.
  • The top three issues experienced by industry professionals.
  • Strategies for working with the 20% of the employee population that is driving the most claims costs.
  • Whether carriers help or present a hindrance.

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Is it possible to help people make and sustain long-term behavior changes that yield better health and reduced claims cost?

This week’s guest, Ted Borgstadt, CEO of TrestleTree, believes that achieving adherent health behaviors for an unmotivated population is possible through a change in the healthcare model.

The current healthcare model focuses more on the 1/3 of patients who are motivated to change and largely ignores the 1/3 who are unmotivated or who are non-compliant with prescribed treatments and protocols.  The problem is that non-adherence is responsible for 10% of overall claims spend. That equates to a $300 billion expense that can be recouped through health-related behavior modifications.

Changing human behavior is a very complicated endeavor. Ted believes that creating a trust relationship is the key that cracks open that door and discusses how this is different than what many think of as a traditional “wellness” program.

Advisors who have typically steered clear of old-fashioned wellness programs due to a lack of demonstrable ROI will find today’s conversation extremely valuable. Solving the participation issue is a win-win for all involved. Ted shares practical strategies that advisors can use to help executives slash health care costs by converting an unmotivated population.

 

What You’ll Learn From this Episode:

  • The scope of the non-adherence problem.
  • How trust is the key to creating influence.
  • The potential financial impact that behavior modification has on claims spending.
  • How to apply a model while still recognizing the individual.
  • Why a demonstrable, repeatable ROI is important in evaluation.
  • Why biometric data is the right place to start the process when providing health and wellness services.

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Saving money by helping to increase consumer confidence and health care literacy should be a priority in today’s often fractured and always expensive healthcare system.

A Thomson Reuters study estimates that health care costs can be cut by $36 billion dollars by helping consumers make smarter decisions. On this episode, Julian Lago, President of Benezon, helps us to learn how advisors can help consumers understand what they don’t know and how to make those decisions.

Managing health care continues to be a reactionary process based on the current situation in which a consumer finds themselves. They tend to scramble when they have an urgent health care issue. Trying to figure out what resources are suitable in a time of need can be confusing and frustrating. Advisors can use a “concierge” type service to extend their value to members by helping them avoid that pre-care confusion.

The rising cost of out-of-pocket expenses and increased complexity of billing systems presents additional opportunities for advisors to provide value-based advocacy programs after treatment. Consumers are rarely aware that hospital bills are routinely error prone and open to negotiation.

Join us for a fascinating discussion as Julian provides insight on trends that impact consumers and how advisors can differentiate themselves by providing extended service.

 

What You’ll Learn From this Episode:

  • How technology is actually helping consumers.
  • Data access and collection trends that will impact the consumer.
  • Why focusing on consumer engagement and repeat use increases consumer confidence.
  • What a pricing-through-billing model looks like.
  • How the health care industry is working to improve user engagement.

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