The challenge for brokers todayis to understand how the care continuum is changing and how to makethemselves an indispensable resource as clients react to thosechanges. (Photo: Shutterstock)

Technology, marketforces and regulations  are expandingthe health care continuum at an ever-accelerating pace. Brokershave their hands full simply processing and understanding the rapidchanges, let alone showing clients how to integrate new conceptsinto a comprehensive benefits package.

Now is a good time to ask the question that's on everyone'smind: Will brokers take on a more critical role in this brave newworld, or do they risk falling by the wayside? The short answer is,“it depends.”

“As solutions become more sophisticated, companies that arebuying those solutions need advisors to sift through them,” saysPrashant Srivastava, PhD, cofounder and CEO of Evive in Chicago,which provides customized health care recommendations. “Brokers whohave been strategic consultants in the past will remain relevant;however, traditional brokers who simply took a piece of the actionon insurance purchases may find themselves disintermediated.”

The challenge for brokers is to understand how the carecontinuum is changing and how to make themselves an indispensableresource as clients react to those changes. First, it helps to knowwhat is causing such rapid change.

Driving forces

The health care and benefits industries have always evolved andexpanded, but rarely at their current speed. Srivastava points tothree factors that are driving these changes.

“The obvious factor is cost,” he says. “As a system, we haven'tbeen able to contain health care costs, which are significantlyhigher than the consumer price index. Payers are constantly lookingfor new ways to mitigate increased costs.

“Second is market changes,” he continues. “When Obamacare firstbegan, the feeling was that in 10 or 15 years, insurance would nolonger be linked to the employer. As we have found over time, thisis increasingly unlikely, and the system of employer-providedhealth care will continue.”

Third is increasing investment in a lucrative business sector.“A large amount of private equity is being poured into healthcare,” Srivastava says. “The technological pace of evolution isattracting venture capital. Technology follows the money. The firstmajor technology trend is big data and tapping into processingpower that big data can provide. This enables us to give people theanswers they need, when they need them.”

So, what are some of the latest trends for 2018?

Virtual care

Teladoc, a telehealth company in Purchase, NewYork, recently made several predictions for 2018. One is thattelehealth is growing up: “The key to transforming health care isto make access to quality care convenient and easy. Virtual healthuses technology, analytics and convenience to empower patients andovercome major barriers to care.”

Another prediction is that utilization will continue to takecenter stage as telehealth enters the mainstream: “As consumers'comfort with digital health gives way to reliance on these tools,telehealth will fill the care gap with access to quality care,wherever and whenever they need it.”

These two predictions go hand in hand, says Dan Trencher, seniorvice president, product and corporate strategy, for Teladoc.

“As telehealth continues to advance, covering more of thespectrum, it will help to further drive utilization, as employershave more opportunities to experience the convenience, quality andvalue of telehealth,” he says. “This will drive up ROI foremployers and out-of-pocket savings for employees.”

Teladoc is working to expand access while improving thetelehealth experience. “Our innovation will continue to be inexpanding our virtual care delivery platform, enabling users to getanswers to a larger array of medical conditions from one,easy-to-use, patient-centric access point,” Trencher says.“Advances in artificial intelligence will also continue, as Teladocdeploys smart guidance in our mobile app and websites to create asimple, personalized experience for members to find the care theyneed.”

Trencher has a tip for brokers: Give new technology a test driveso they can recommend it to their clients with confidence. “Brokersshould get and use telehealth themselves,” he says. “Once theyexperience the value for themselves, their enthusiasm and passionfor it will be contagious for the employers they are workingwith.”

Highly personalized recommendations

Health care is moving quickly from a one-size-fits-all approachto more specific recommendations. Evive is helping this happen byimitating two online powerhouses, Srivastava says.

“Evive is Amazon meets Google meets benefits,” he says. “Amazonprovides personalized recommendations, and so do we, based onprevious purchases, a profile of who you are and how you use thesystem for the right recommendations at the moment. We also arelike Google in that you see recommended ads. We built an ad networkthat puts recommendations in your HR portal, application or payrollsystem.”

Ten years ago, Srivastava saw a growing trend in retail andapplied it to health care. “We noticed how the use of retailcoupons was evolving,” he says. “The discount paper suddenly becamepersonalized to you. Health care, trying to become a moreconsumer-driven business, should do the same. Nowhere is it moreimportant than in health. It provides the information you need,when you need it. We had the data but just were not using it.

“How about using the same technology, as it relates topersonalized recommendations, in an area where it is sorely needed?If we can help people make better decisions about health, we aredoing the basic blocking and tackling. How can you make betterdecisions when it is time to pick a drug or health plan?”

Simply put, Evive mines health care data to match individualswith the best care options.

After initially targeting large companies, the Evive concept isnow cost-effective for small businesses, as well.

“Employers typically invest about $10,000 in benefits, and a lotof that is in health care,” Srivastava says. “Costs are rising 4percent to 7 percent each year. The strategy to control cost isworking with a bunch of providers. Our ROI comes from increasingthe savings in each of those categories.”

Although the technology is cutting edge, the concept is simple:“It requires tools, marketing of tools, and measurement of thosetools. The latter is what we do.”

On-site care

Providing health care benefits is one thing; maximizing theiruse can be quite another. On-site or near-site primary careclinics improve both heath care and employee engagement, say PeterDunn and Debra Geihsler, principals and cofounders of ActivateHealthcare in Indianapolis.

Activate works with organizations to set up and manage primarycare clinics as a benefit for their employees and their families.Organizations usually pay a fixed amount per month or a fixedamount for each worker and family member who has access to theclinic. No insurance claims are processed, and members and theirfamilies usually enjoy unlimited access at no cost to them.

“Clinics represent 5 percent to 7 percent of total health carecosts, and organizations often reduce total health care costs by 10percent to 25 percent,” Dunn says. “On average, organizations getback $1.40 to $1.50 for every $1 they invest in services.Demonstrated health care improvement—and avoiding related costsdownstream—is the primary source of the savings.”

Dunn, a former CEO of a large business, and Geihsler, a formerhealth care executive, started Activate in 2010. “We felt we werenot giving good value to payers and patients,” Geihsler says. “Wewere not focusing on the person behind the health problem.”

Dunn drew upon his own experience of providing health care forthousands of workers.

“We had a huge health care bill,” he says. “The trends toprovide excellent care to employees at a reasonable cost were notgreat. I had a background in product development and used it onunsolved problems in health care. I learned that three-fourths ofcosts are from chronic conditions. It was an 'aha' moment for me.Proactive primary care can have a dramatic impact on costsdownstream. Employers are already funding all of health care, sowhy not do what works?”

Constant communication with clients and their employees hasdriven up participation percentages.

“People often ask, 'How do you get more than 90 percent employeeparticipation?'” he says. “Clients are involved in everything wedo—who we hire, the name of the clinic, the hours and how we openthe clinic. Everything we do is based on the people who areaffected by the clinic. We meet in small groups with every one ofthe employees and their spouses, so everyone gets the full message.After it is launched, there is an ongoing process ofcommunication.”

The ROI is both measurable and impressive.

“We measure ROI across all clients and the total book ofbusiness,” Geihsler says. “The ROI gets better after the second,third and fourth years. Some employers who have been with us forseven years see a 200 percent ROI.”

The result is win-win for clients and patients—and also brokers.“Brokers get more loyal clients by integrating proactive on-sitecare with cost savings,” Dunn says. “Brokers are at the table atevery stage of the relationship.”

Another unique aspect is the three-year contract for companiesthat join. “This benefits brokers, who typically have a one-yearcontract,” Dunn says. “It locks in the benefit and cements therelationship between the employer and broker.”

Prescription for success

The care continuum also continues to address the availabilityand affordability of prescription medications. Express Scripts inSt. Louis, which fills 1.4 billion prescriptions for 83 millionmembers each year, leverages competition and market dynamics.

“Affordability and increased access to prescription medicine arethe two factors that continue to drive changes in the health careindustry,” says Christine Portell, senior manager, communications,for Express Scripts. “When affordability and access requirementsare met, the result is better health outcomes.”

Express Scripts recently outlined three trends that are shapinghealth care:

• Value-based care. This protects patients and payers fromskyrocketing drug prices, while delivering better healthoutcomes.
• Personalized clinical care powered by technology. For example,pharmacists using remote monitoring can leverage data from sensorson inhalers or glucose meters to identify trends or gaps in careand perform counseling using patient-specific data, minimizingnegative downstream health events.
• Data across the care continuum. The health care industryproduces a large amount of data, but in many cases, information andinsights derived from this data are poor. To effectively managecosts and care, and to take on national emergencies like the opioidepidemic, smarter pharmacy practice is needed.

These trends can benefit brokers as well as patients, Portellsays.

“When we improve our support of prescribers, we're ultimatelyimproving patient care,” she says. “So insurance brokers will wantto consider the significance of connected health care. Electronicprescription and prior-authorization channels are faster and moreefficient methods to ensuring that patients are prescribed the mostcost-effective and clinically appropriate medications.

“While fax machines have been disappearing from businesses andhomes, they're still a fixture in many medical offices,” Portellcontinues. “Electronic prescription and prior authorizationeliminate the paperwork and time-consuming hurdles. The turnaroundtime for a decision is usually seconds to minutes, rather than thedays it might take for a decision with a faxed prior authorization.Getting the right medication to the right patient in the mostefficient manner is a major step in reducing costs and improvinghealth outcomes.”

Advisory role

A comprehensive look at the expanding health-care continuum for2018 and beyond would likely fill a book. The more pertinentquestion for brokers is how to best position themselves to thrivein this ever-changing world.

“Self-service options enable purchasing without the need for abroker,” Srivastava says. “Brokers must shift from a traditionalmodel to an advisory model, just as Charles Shwab now is more of anadvisor for investors.”

The best way to do this is to engage with the employers, who inturn engage with employees.

“The key to engagement is to follow what the rest of the worlddoes,” he says. “If I am a retailer and want to sell something, Iput my merchandise in the right place and display it the right way.Brokers and HR professionals need to think of themselves as productmarketers. Benefits include a lot of products, so you need to makethat product line attractive. Do what retailers would do. Providethe right message to the right population at the right time. Thinklike a marketer.

“If General Motors made a lot of cars and had no advertising tosell them, or if brokers bring solutions with no engagement tools,they are not realizing the savings they have.”