Nextyear will be a big one for design as more benefits advisors andemployers break away from incremental additions and subtractionsand begin to move in very new directions. (Illustration: FayeRogers)

December is a month for celebration, reflection and expectation. Wedecided to leave the first two to others and focus on the year tocome in five categories: technology, plan design, management, costcontrol and broker business.

We cast our net far and wide, soliciting our readers’ input onsignificant events and trends for 2019. We spoke with consultants,health care executives, benefits and HR managers, vendors and somewho position themselves simply as seers. After culling theresponses, we offer our best highlights of what’s to come in 2019.Thanks to all who participated. Once again, we were buoyed by yourenthusiasm and thoughtfulness. Here’s to a great 2019!

Related:6 economic predictions for the next 5years

Technology: More work for machines, higher quality forhumans

Insurance and health care held out against technology as long asthey could, but once they came around, the marketplace was morethan ready. The big trend for 2019 in health care will be telemedicine. Building on a strong showing in2018, telemedicine is blockchaining its way throughout medical careand finding its way into most benefits packages as its applicationsincrease. It’s facilitating better care for employees, where andwhen they want it. Onsite clinics, remote physician services, andmobile apps connecting patient to provider will all proliferate.Small businesses will unite to access such services.

“Telemedicine, particularly via mobile video, is on its way tobecoming the standard for this generation,” says David Reid ofEaseCentral, provider of an HR and benefits SaaS platform forinsurance brokers.

Some see these technologies as eliminating certain roles—theinsurance company’s, for instance.

“New technologies, including blockchain, are on the verge ofenabling companies of all sizes to use smart contracts and otherautomation to administer plans,” says Dr. Jerry Beinhauer, MD,Founder and CEO of Appley Health. “By taking advantage of theseadvances, companies can remove insurance companies (and their highcosts) from their health care equation. The gravy train will soonbe pulling into the station.”

Meanwhile, artificial intelligence and its counterpart,machine learning, continue to find new applications in health careand insurance, performing the twin functions of stitching businessactivities together and simplifying them. Many new products drivenby AI are targeting HR functions, such as recruiting and employeesatisfaction surveying. Machines can do it better, their creatorssay—and some have the evidence to back up their claims.

Prognosticator Alex Burggren, enterprise sales director forchannel partnerships at Virta Health, says, “AI and machinelearning are buzzwords that get thrown around a lot, and in 2019we’ll see more scrutiny on how these technologies are actually usedand how they are making a difference in patient health and leadingto longer-term engagement via technology.”

However, he cautions, watch for a bit of a backlash against allthis AI and ML next year, as vendors get pushback from customers onproducts and services without clear and sustainable outcomes. “Weare already starting to see focus shift toward full-stack healthcare companies that leverage technology as an important component,but not the only one,” he says.

Plan design: Don’t iterate the old plan, give meinnovation

Next year will be a big one for design as more benefits advisorsand employers break away from incremental additions andsubtractions and begin to move in very new directions. Sure, therewill still be some of the usual enrollment song-and-dance of anincremental increase of coverage costs to employers, followed by a“new plan” that often takes away yet more from employees. Butemployers, consumers and brokers are getting smarter faster, and2019 will see another big shift toward plan design innovation.

Voluntary benefits’ inclusion will grow as plan design seekscustomization to plan member needs. Susan L. Combs, of Combs &Company, predicts the emergence of more creative benefits, such ascollege loan repayment companies; the inclusion of loss of lifeadvocates in plans to help those who have lost a family member butstill need to remain present at work; and a greater range ofbenefits for females.

Wellness programs will be expanded where metrics supportexpansion or where they are seen as cost-effective. MarissaCostonis, a health change coach and author, says plans will focusmore on health coaching, low-cost, on-site wellness practices suchas massage, meditation rooms and desk-based workouts, and usinghealthy food as an incentive or reward to improve employeesatisfaction and productivity.

Radical departures from the old ways will be on the rise, suchas direct contracting for various services (primary care, mentalhealth services, routine medical procedures); plans built to handleemployer/provider partnerships; and new ways for managingpharmaceutical costs. Brokers at the cutting edge will be advisingtheir clients on such plan designs, as more adopt the role ofconsultant and advisor rather than sales person.

Says Dave Chase of Health Rosetta: “I foresee a backlash againstblunt-instrument high deductibles, creating an explosion of the‘functionally uninsured’—that is, with more than 50 percent of U.S.households having less than $1,000 in savings and more than half ofthe workforce having a deductible greater than $1,000, millions ofAmericans are a bad stubbed toe away from financial ruin.”

PPO networks will decline, he predicts, as design follows twodivergent paths: One toward narrow networks, the other a move awayfrom traditional networks altogether—using either reference-basedpricing or transparent open networks, the successor to PPOnetworks.

Management: Better data means better management skillswill be required to survive

As plan design shifts rapidly, employers, health care systemmanagers and brokers will need to develop new skills and thinkcreatively to meet the demand for someone to manage these newarrangements. The driver: Better control over relevant data. Asemployers insist on more control over data, they are crunching itmore effectively. Those who can master data management willsoar.

The key here will be the rise of managers on the employer sidewhose role is to manage and understand their health care data andthe cost components of their insurance and health care services.These new managers will be innovators, seeking the rightpartnerships that improve outcomes on the health side whilereducing cost on the provider side. More companies will either havea Chief Medical Officer on staff or one on retainer to collaboratewith brokers and providers. Here’s something else to keep an eye onfor 2019: Health care supply chain management will become aprofession. So says Nelson Griswold, president of agency-growthadvisory Bottom Line Solutions, who serves as managing director ofthe NextGen Benefits Mastermind Partnership.

“This will be a new job description for employee benefitadvisors,” he says. “Health care supply chain management is a brandnew concept. This allows you to take a typical self funded planbased on hope and turn it into a high performing health planbecause you are managing the costs. This is not about the lowestprice. It is ensuring the highest quality at the lowest price.”

As these managers emerge, we will see formation of more creativeemployer/provider partnerships. Accountable care organizations andsimilar employer/provider partnerships will become popular asemployers seek to reach into hospitals and clinics to force moreaccountability—and lower health care costs. Those who manageemployee/health data will be tasked with analyzing it with a viewtoward matching the health care delivery system with what the datasays is or is not happening.

On the health care side, providers will need to find the peoplewho can respond to employer demands for improved outcomes. Andbrokers will need to steer more young talent into advisory andconsulting roles, where they can truly form partnerships thatemployers will be demanding.

Chase adds an ominous 2019 challenge for employer-sponsoredhealth plans: Legal risk concerns shifting from basic ACAcompliance to lawsuits against employers. “There is a significantliability around fiduciary duty,” he says, indicating that bothERISA fiduciary duty and shareholder fiduciary duty could behighlighted. “In both cases, class action law firms have recognizedthat employers aren’t properly stewarding the resources that theyare duty-bound to care for, as it’s so simple to cut spending by 20percent or more using various proven cost containment tactics.

“The other employer legal risk is around opioids. So far, thereare fifteen lawsuits filed against employers by surviving familymembers of employees who overdosed. As they dig into what happenedto their loved one and see the extreme volume of opioids that theemployer allowed to be prescribed, they are seeking to holdemployers accountable for not flagging obvious abuse. As moreplaintiffs and attorneys become aware of this, and with theextremely high volume of overdose deaths from prescription opioids,there’ll be a ramp up in 2019 accelerated by the public visibilityof the umbrella opioid lawsuits/settlements against theopioid/pharma supply chain. This is now extending toemployers.”

Cost control: Make it work better and cost less

In 2019, our crystal ball gazers say cost control will take newshapes and forms.

The big one here is also a management theme: Employer/providerpartnerships, which, in early experiments, have slashed overallemployer health costs dramatically. Some of the early adopters(Whole Foods in southern California, Walmart in Louisiana) soughtto save money in part by eliminating insurers altogether from therelationship. As brokers begin to envision their role as connectorsof the parties, they will validate their participation and be seenas cost-conscious and outcomes-focused rather than commissionchasers.

Professional employer organizations (PEOs) may begin toconsolidate, since too many were spawned in the last two years.“This past year we have seen a push for more of these companiespopping up and the market is becoming very saturated, so I think wewill see some consolidation here,” says Combs. But the concept willattract more employers as they understand the power incollaboration.

Certain products, services and processes will emerge in 2019that are specifically designed to reduce cost. Some won’tcontribute to better employee health or health coverage, likeskinny plans a la Trump. But they willproliferate if legal conditions are right. Others will be marketedas triple-aim achievers, as more new products and services layclaim to immediate double-digit savings boosters.

Of course, not all will live up to their billing.

Meantime, at the large employer level, groups like the NationalBusiness Group on Health will continue to explore new pathways tobetter cost management. Among the items on their radar for 2019:half of employers (51 percent) identified implementing more virtualcare solutions as their top health care initiative in 2019; 35percent will have alternative payment and delivery models such asaccountable care organizations (ACOs) and high performance networks(HPNs); and more employers said they will turn to directcontracting with health systems and providers and directcontracting between employers and centers of excellence (COEs) nextyear. The employers want to see better health outcomes for theirspend, but they expect those to come at a lower cost. Next yearwill offer evidence for which strategies achieve that. The onesthat don’t won’t be around long.

Broker business: Time to move into the 21stcentury

The big one here was discussed in BenefitsPRO’s November coverstory, “Breakaway Brokers.” A total broker mindshift,from annual maintenance to annual overhaul and even “throw yourplan out” strategies. The profile of the broker success stories of2019 will describe the brokers’ transition from commission-based,limited-product service provider to year-round advisor/counselorwho brings parties together to achieve mutually supportiveobjectives. Brokers that can’t bring these strategies to theemployer will soon be out of business.

Meanwhile, to be able to move swiftly and stay relevant, manybroker businesses need a technology overhaul, and that will be atheme next year as well. Last here is the increasingly painfulshort supply of top people needed to drive these new brokerbusinesses. The talent battle will escalate.

Jason T. Andrew, CEO and founder of Limelight, a technologydriven support system for brokers, says two of his top three 2019highlights are tech-focused. “The insurance industry is not knownfor automation or AI,” he says. But there are a number of veryinteresting things taking place around both of these topics. Forexample:

1. The elimination of vast amounts of work now done manually asinsurers finally accept the inevitability of automation and AI.“Allowing technology to take on some of the manual administrativetasks will enable all of us to focus on more important andstrategic tasks that will provide for a much more meaningful anddata-driven engagement in all facets of the interactions whenrating, buying, selling and engaging with employee benefits.”

2. Greater internal connectivity through API will begin tostreamline insurers’ back shops and front-facing customer service.“Currently, most carriers, brokers, and employers use multiplesiloed systems. Because of this, you lose what would otherwise be asubstantially simplified and meaningful workflow. We are seeing agrowth in connectivity but we are at a very early stage.”

3. The battle for talent acquisition will escalate in 2019 asmore brokers age out and others get out rather than adapt to theindustry’s new demands. “Over the next few years, we expect up to40 percent of licensed folks (the average age is 59) to retire.This presents a huge problem for our industry. Contrary to whatmany say, which is that brokers and agents will be disrupted bytechnology, I think we have the opposite problem: a massiveshortage of qualified and licensed people coming into theindustry.”

More insights into the year tocome: 

• 4 trends in employee wellness programs for2019
• 5 trends to expect in voluntary benefits in2019
• Surprise! Medical costs will rise again in2019