Tom Garner, executive VP operations and network development, SkyMedicus Inc.

Siloed benefit programs

Many traditional medical brokers ignore or overlook the gains of integrating health insurance with other benefit offerings.

As traditional medical carriers have recently moved into the ancillary and voluntary arenas or formed strategic partnerships with non-medical carriers, there are new opportunities to uncover savings. Additionally, increased participation in a voluntary program can drive savings to both employer-funded ancillary and medical lines. Lastly, there are value-adds that are often overlooked or lost in the implementation process, including medical cross-sell discounts, outsourced FMLA solutions, marketing allowances, technology offsets, wellness fair reimbursements, telemedicine and EAPs.

Kevin Kennedy, benefits consultant, TriBen Insurance

Can I get a price check?

Health care is the one thing on a retail platform that doesn't have a price tag. We all know that our health care system is broken, but the ignorance of how to utilize health insurance and navigate health care by most of America is just adding fuel to the fire.

I'm not sure how we “fix” our broken industry, but I firmly believe we can improve it through education and transparency. Consumers only see the tip of the iceberg, which consists of the “discounted” cost. What isn't seen is the enormous remainder of the iceberg hidden under the water—the total cost of care. This shouldn't differ based on where you seek care, but it does and will continue to; therefore, we have to help consumers become smarter.

Devan L. Sebek, director, benefits management, Mosaic Employee Benefits

Recognizing the problem

The lack of understanding about how the entire process works is the biggest concern I have. For years, members thought, “my insurance will cover it.” Or “I have insurance; who cares.” No one understands how insurance works.

Who funds the insurance and pays the premiums? How much does an insurance company make? What if I never use my insurance? We don't slow down enough to think about the bigger picture. Think about your car or liability insurance for a second. If you get a rate increase, it's typically due to claims. Why does your health insurance increase? Typically because of an increase of claims. Now the fun starts: How do we control the frequency and severity of those claims? Before we implement solutions, we have to educate the public on how the system works and how it is broken.

Taylor Y. Lindsey, partner, Employee Benefit Consultants

Profit distraction

When health care became big business, we all transitioned from being patients to customers. Profit distraction is a systemic issue, and until we truly balance cost and quality, it always will be. Patients pay many times over, not only in rising cost of services, but in rising health insurance, and when quality care, better practices and lower cost alternatives are overlooked. We clamor for cost transparency, but also need to focus on quality transparency.

For a recent surgery of mine, more time was spent pushing the idea that I pick up prescribed medications at the hospital's pharmacy than was spent describing how to change bandages and care for the wound. No wonder readmissions and post-op infections are on the rise!

Here's a suggestion for hospitals: Why not send patients home with a no-cost “get well soon” kit, which includes hospital-grade bandages, visual instructions, a 24-hour post-surgical video chat, and more? Instead, members are left to their own devices, wandering the aisles of CVS and phoning a friend.

Derek Winn, benefits consultant, The Business Benefits Group

Better shopping experiences

If the provider market functioned like other markets, we would be able to shop around for elective services like we do for other products or services. I should be able to determine my cost before I get the procedure done, rather than being billed after the fact.

If I choose to shop around, I control the choice of provider and the cost. There are some great services emerging that help with this, but not everyone has access to them. I believe that placing this control back in the hands of patients will help bring down the cost of care, just as it has with Lasik surgery.

Jacqueline St. Hilaire – D'Alessandro, evangelist, NextAgency

Drugs of choice

One of the most misunderstood items is Rx pricing and the broken system of discounts, kickbacks and lack of transparency. Consumers have no idea how the system works and only think about their $10 generic copay, not the real cost of the drugs. They don't understand that there are less-costly alternatives or generics, and brand name drug coupons raise insurance premiums. The system needs to be changed or we will never control health care costs.

Barry S. Cohn, president & CEO, Really Great Employee Benefits

Access points

In recent years, we have reversed the emphasis from access to care first and catastrophic coverage later to catastrophic coverage (high deductibles and referenced-based pricing) first and first-dollar access all but eliminated. Our philosophy for low-wage workers is to provide low-cost, first-dollar benefits with voluntary catastrophic ancillary coverage for the low percentage of employees who may need it.

William Hammett, principal officer, Hammett Insurance Services

On-demand pricing

The disconnect between cost and the purchase decision is, and has always been, the thing most broken in our health care system. Patients today still have very little knowledge about the cost of services, and they don't care because they aren't paying for it directly. Most of the cost is being spread across a group or carrier's block of business so the patient's decision has a minimal impact on his or her own health care costs. Even if plans incentivize the patient, the pricing is often very difficult to get.

The fix to this isn't simple, but I think the first step is price transparency. Providers and facilities should be forced to publicly share all pricing or, at a minimum, provide pricing info on demand to a patient who requests it. Once we all know the cost, we can start working to control it.

Brad Vernon, health actuary, Benefit Innovators, Inc.

Robbing Peter to pay Paul

With health care premium expenses increasing year after year, the decision to degrade coverage to curb costs seems simple and intuitive. But employers' tunnel vision surrounding the need to control costs has made them miss the costly consequence: increases in talent management costs. The tight talent market has employers battling to recruit, but they struggle to do so without attractive health benefits. Unwilling to spend more on benefits, employers turn to taxed bonuses and compensation, driving up expenses in addition to recruitment costs. When you factor these in, employers really aren't controlling costs at all.

Caroline Moore, marketing and communications manager, ArmadaCare