Doug Hetherington is VP of Employee Benefits with the Echelon Group in Boise, Idaho. Echelon provides a variety of services, ranging from individual insurance and asset management to employee benefits and retirement plans.

Paul Wilson: How did you get started in the benefits industry?

I always loved skiing and graduated with a degree in hospitality management. I moved to Sun Valley and realized I'd made a huge mistake, so I ended up being a headhunter for a few years. The dot-bomb hit, so I started gravitating away from software engineers and technical folks and working more with local businesses. My mom was a producer in the employee benefits business and a partner in a firm based in Twin Falls, Idaho, so I started doing some side work for them, looking for producers and account managers, and was recruited for the job myself in 2002.

PW: How has the industry changed since you joined it?

I would love to say it's changed a lot, but in my opinion, it really hasn't. But what is changing is the rate of change. We can thank the recession in combination with the passage of health reform for exposing the problems, not just at the employer and professional levels but also at the employee and even societal levels. As a result, there is more desire for solutions and willingness to change. We've hit the tipping point.

PW: What are the biggest challenges you've faced when presenting innovative strategies and ideas to clients and employees?

It's getting them to start, to become motivated about this paradigm shift. I've learned when you sit down with an employer, you've got to own it. You have to throw traditional under the bus and then back up over it. If you're going to walk in and discuss cost-containment, innovation and doing everything differently, you've truly got to walk away from the status quo. You also have to be able to explain why your solutions make better sense. Getting an employer to begin that process is probably the biggest challenge.

After 25 to 30 years of pain and suffering, we all want a solution so bad, but we're also afraid. Could this actually make it worse? What does the solution look and feel like? The reality is, very few have experienced it at this point.

PW: So many strategies rely on building good data. Do you think the process will get easier over time?

It's one thing to look at data on a national level, or even on a regional basis, but when you can bring that down to the employer level, or even a per employee per month, you're beginning to discuss real numbers.

I started out by getting into the captive space in 2013, and our first group with reference-based pricing and a captive combined in 2014. Now, we're really starting to see the data. With our first few groups—and it's true with the next few as well—we see cost savings and cost avoidance. It was one thing to talk about it, but now that we can show the numbers, employers are very willing to have a conversation.

One of the things we've done over the last year is to become extremely transparent. I walk around with my client list of references and pass that off to an employer. My clients know those calls may be coming; they are looking for more partners who want to jump on board, and as that happens, it makes my job a lot easier because, in essence, the problems we've solved for our clients are what's selling our future clients.

PW: How are you taking advantage of the turmoil and change occurring in the industry?

The day after health reform, my mother, who was very successful and the person I looked up to most in this business, called me and said, “You need to get out.” That was her last year in the business, and at that moment, I didn't necessarily disagree with her. But I received another call later from my father, who I never took career advice from, and he said, “You know, I think your mom gave you some bad advice.” What he basically told me was, “Go solve the problem.” And that's what I set out to do.

The first thing I focused on was trend. I had learned a little about captives on the P&C side, and had started poking around to see if there were any on the benefits side in late 2010 or so. That's when captives were just starting to pick up a little bit. I partnered with a fantastic captive reinsurer and manager and I was introduced to several vendors that dealt with data. I was also introduced to reference-based pricing.

I ran a parallel track of trying to market both a captive and reference-based pricing, but the two ended up melting together. At the beginning of 2015, we launched a captive where every employer was required to be reference-based priced. I partnered with a broker on the East Coast, and we put our clients together and formed that captive, which continues to run very successfully today. It has gone national through our reinsurance vendor and has 24 employers. We're really excited about the growth that we've seen; and the savings have been tremendous.

We're now at a point where we're able to look at it from an actuarial standpoint and have a high level of credibility. Our initial group within the captive has reduced its trend to a spot where we're less than $250 on a per employee per month basis, and we have improved benefits and/or reduced cost share to the employees every single year since they've come into the program.

PW: All this transformation and change brings opportunity, but what about the challenges you're facing?

What I think is interesting is my competition isn't necessarily other brokers as much as just the status quo in general. So it's all about education and walking your prospective client through why health plans operate the way they do in order to give them a good understanding of why the system is failing and then identify their anxieties and deal with those one on one. People often ask, who's your competition? I say, well, it's probably the largest insurance company and the largest hospital in my state, and that adds up to four of the eight largest employers in my state. So I feel like I have plenty of headwinds coming at me, they just might not be from the directions where some other brokers feel it.

PW: How do you remain innovative without becoming distracted or overwhelmed?

Things are changing faster and faster, and while it's incredibly exciting, a lot of what's coming into the market is bright, shiny objects. I've noticed we're starting to gravitate toward just a handful of vendors. There are going to be challenges with solving the cost problem of health care, and when those challenges come up, what do you expect out of your vendor? We're looking for partners. What value will they bring? When the going gets tough, how will they execute? What's their track record? I would rather perfect our processes than continue to change on a regular basis, which has the potential to muddy the waters and disintegrate our processes.

PW: What makes you excited to get out of bed every morning?

Fixing health care. The television was invented in a little town called Rigby, Idaho. Wouldn't it be interesting if in a couple of years, I could say, “Hey, remember when we fixed health care right here in eastern Idaho?” If I can someday look back and say, I had my thumbprint on helping solve this problem, and ultimately helping people access good, effective health care at a reasonable price and that has a long-term ripple effect on society, how could I be more proud of what I accomplished in my career? I wake up excited because we're making progress and it feels like we're going faster and faster by the day.

PW: What are your sources of inspiration?

When I hear stories from clients or employees, it brings it home that, at the end of the day, this is about people. I've done the research on the financial shift that's taken place since the introduction of health reform. If you got a dollar raise during that period, you're now spending 79 cents so you can still afford to have health care. I know too many employees who can't afford to have their spouses and children on there, and that makes me sick to my stomach. That's my motivation.

PW: Finish this sentence: The key to success in this industry going forward is…

Don't be afraid to question the status quo.

Instant Insights /

Competing against the status quo: A Q&A with Doug Hetherington

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