Editor's note: This is the second of a two-part series on the recent Q4Live member conference. The first part featured Tony Moore, Dave Chase and Jeff Bernhard.

Adam Russo

"We need people who want to drive the bus, to help make change happen," Adam Russo told attendees at the recent Q4Live conference in Tampa, Florida. "We have an amazing opportunity, but if the employee doesn't change his or her behavior, nothing else matters."

Russo, co-founder and CEO of The Phia Group, knows all about changing behavior. His company's health plan, which has been self-funded for more than a decade, was recently featured in the Boston Globe. The secret to their success? "We pay our people to give a crap."

He explained how the company drastically cut their health care costs and improved care by incentivizing employees in "ways that will blow your mind." Here are a few examples he provided:

• No copay for urgent care

• No copay for non-hospital facilities

• No copay for prescription drugs and supplies

• Plan participants who identify erroneous charges on medical bills receive 20 percent of the savings

• Plan participants who find alternative means to purchase supplies or care get a percentage of savings

• Pregnant members who use approved facilities that have been deemed safest get $300 a month, for one year, to use on diapers.com

• Members who consult with HR regarding planned medical procedures receive $100

The key, Russo emphasized, is changing the way people behave to get them to realize they are consumers of care. "With all due respect," Russo said, "you're not brokers anymore. You're experts; you're advisors. People expect you to give them expert advice."

In closing, Russo acknowledged that the majority of advisors and their clients likely won't take the necessary steps to make change possible. But those who do take the time to find out what their clients truly need and who are willing to take revolutionary steps to make it happen will see a dramatic difference, he added. And he has the results to prove it.

Alex Lickerman, MD

After speakers provided strategies and ideas that trailblazing advisors and employers are utilizing to change health care, the discussion moved to another key player: providers.

"I really believe direct primary care is the future of medicine," said direct primary care physician Alex Lickerman, founder and CEO of ImagineMD. "It's actually what medicine should have always been."

Lickerman provided convincing evidence regarding the broken state of health care in the U.S. and the damage that is being done in areas ranging from access to utilization to cost.

For example, he noted that:

In most major U.S. cities, it takes an average of 20-23 days from the time an appointment is made until a patient sees their primary care physician.
Once in the waiting room, 30 percent of patients will wait 20-40 minutes to see a physician in urgent care or mini-clinics.
Once a patient sees the doctor, the average amount of time spent with them is only 15.7 minutes, an "entirely inadequate amount of time."

Lickerman also detailed how, despite common consensus, America does not have the highest quality health care system in the world — or anywhere near it.

In fact, "The medical system itself is literally one of the most dangerous risks that Americans face," Lickerman said, noting the hundreds of thousands of deaths that occur each year as a result of complications or tests in which no error is committed.

"My job as a primary care physician is to protect my patients from that."

Lickerman emphasized that most doctors hate that the system often no longer allows them to take great care of their patients. But the direct primary care model allows doctors to spend more time examining and talking with patients, he added. "A doctor's schedule should never be the bottleneck preventing the attention a patient needs. It's really all about having the time to get to know the patient and letting them get to know their doctor," he said. "It transforms the experience of medicine."

David Contorno

"If we don't make people uncomfortable, they won't change," said David Contorno, employee benefits practice leader for the Hilb Group. While admitting to occasionally losing clients by pushing them too far out of their comfort zone, Contorno emphasized that "the trend [in health care] is clear; this is not sustainable."

Contorno, who is viewed by many of his peers as a pioneer in bringing about change, admitted that "the whole system is designed to keep benefits brokers and consultants doing what they're doing. It's hard and you have to want to change. But the other side is amazingly gratifying."

While it might be tempting to experiment with new and innovative strategies on prospects, Contorno argued that brokers have a bigger obligation to bring these ideas to their existing clients.

He shared stories of his own successes with self-insurance, reference-based pricing and transparency around the fees he receives for his services. "If you can't look your clients in the eye and tell them what you're making, you're being overpaid," he said.

He also detailed the impact that medical facilities have on the quality of care, and how the data that's now available can help employers and their employees make better decisions. And he has firsthand experience. Contorno recently traveled to the Surgery Center of Oklahoma to have an inguinal hernia repair performed. The Center, which is entirely cash-based, lists its all-inclusive surgery prices on its homepage. And those who visit the site tend to experience a completely different type of sticker shock than they're used to when it comes to medical procedures. One facility near Contorno's home in North Carolina (which was rated more poorly) quoted him $47,500 for his surgery. Under his health plan, he would have had to pay $9000 of the total. The price at the Surgery Center of Oklahoma? Just $3,050.

Whether you're a benefits consultant, an employer or a health care consumer, you don't have to be a genius to get on board with the changes occurring right now in the health care and benefits space, Contorno told attendees. "All you need is common sense and a willingness to change."

"The last few years, the pace of change has been overwhelming," Kevin Trokey said, as attendees prepared to head home. "Yes, it's faster than it's ever been before, but it's also slower than it will ever be again." In order to succeed in this new environment, benefits consultants must have a vision of where they're going, and the resources, skills and people they'll need to get there.

"The easy world many of us came into in this industry is long gone," he said. "We need to celebrate that. The bar has been raised."

Instant Insights /

Raising the bar: benefits consultants discuss groundbreaking ideas

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