Emma PasseEmma Passé is anaccount executive at EBMS and an outspoken advocate for cost transparency using analytics, reference-based pricing, and a consultativeapproach.

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Paul Wilson: How did you get your start in the benefitsindustry?

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I was born and raised in England. When I arrived here at 18, theconcept of health insurance was about as foreign as I was. My veryfirst job was as a claims assistant and administrative assistant atThe Standard. Eventually, I made my way into medical sales andservice and for whatever reason, I’ve always been assigned tonational accounts, which means I’ve only ever worked with largegroups. And now I’m the person everyone comes to to betterunderstand how insurance works. It’s really taken a massive turn inthe last 14 or so years.

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PW: What are your thoughts on universal health care inthe U.S.?

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I don’t usually speak up about it, but with the debate going onright now in the U.S. about single-payer, I keep hearing that it doesn’twork, or that people don’t get care, get sick and die. And it’ssimply not the case. As someone who grew up in the system, I cantell you that what happens in the NHS is prioritization. If I’mrushed to the hospital with appendicitis, I’m going to get myappendix removed immediately. Whereas if someone walks into theA&E with a sprained ankle, they’re probably not going to getimmediate service. The people who receive the care fastest arethose who need it most.

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Related: How America’s broken health care system came tobe

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To me, that model makes perfect sense, but I don’t think it canbe implemented here, and I think most of that is politicallydriven. It has a lot do with the misconceptions about how universalhealth care really works. There’s hesitancy to allow the governmentto have its hands in health care, and I also think people are setin their ways and just used to this system. But we can at leaststart by offering health care to everyone and fix the accessibility problem. I don’t think the healthsystem over there is perfect, but it’s certainly not as narrow asmany people here believe.

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PW: What’s your perspective on the industry these days?What are the biggest opportunities and challenges youface?

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The biggest challenge I’m facing is adversity in terms ofopinion. Just today, I met with a consultant who has been in theindustry for a long time, doing the same things that have proventried and true. That’s difficult to overcome, because I actuallytrack data and am able to see what does and doesn’t work in termsof cost-containment.

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So many brokers are used to an older model that generates acertain percentage of premium and commission, and they’re reallyscared to break out from that. The problem is that you’re not ableto provide much of a solution if you can’t do somethingdifferent.

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Most employers I talk to are intrigued by what’s available, andmany times, it’s something they’ve never heard of before.

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PW: What successes have you had in changingminds?

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A client of mine has a really high-dollar claimant on theirbooks right now and they’ve been dealing with it for a couple ofyears. They’re more of a traditionally self-funded client and theyfinally got to a point where they realized, “We have no choice butto try something different, because our company just can’t sustainthis anymore.” It’s unfortunate that people get to that point whenwe could have addressed it a year ago. Again, the hesitancy comesfrom a place of fear: “What will my members think? What will theirexperience be?”

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We’ve had many successes, though. We had one client we took from$11 million down to $4 million in claims in just 12 months. Youjust have to have a certain level of bravery and trust to step intoit. But as long as you have good consultants who can really back upthat data, you can establish quite a bit trust to get someone tofollow and have a better outcome.

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PW: It’s key to maintain quality while cutting costs.What strategies work?

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Direct primary care is definitely part of that. We also workwith a few different RBP vendors and the best ones have proprietarysoftware that actually tracks the quality of facilities andphysicians. They reach out and make direct contracts with localhospital systems providers and they ensure that members arereceiving quality care. You can wrap RBP with care quality and havethe entire package available.

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PW: What reactions are you seeing from providers when itcomes to RBP?

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The biggest pushback is coming from the heavy-hitting hospitalsystems. The cost of services in bigger facilities tends to behigher, so they tend to be more adverse to writing off a largerdelta between what was billed and what was actually paid.

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You can start by asking a provider, “Do you take Medicare?” Ifthe answer is yes, then it shouldn’t really matter who the patientis. If you usually take Medicare pricing and we’re offering tobuffer it at 30 percent or 40 percent more, there shouldn’t be muchpushback. The second thing is, you should have your percentage at areasonable amount—you really want to be at 140 percent or 150percent. Show them they’re still going to get paid fairly andwithout a lot of the headaches they face with the more traditionalmodel.

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PW: How will transparency in health care continue toplay a role going forward?

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One of the pioneers in transparency is Pearl Health Partnershere in Portland. Dr. Richard Rosenfield runs the practice, andhe’s created a network of gynecological surgeons. He’s been veryoutspoken about bundled services, quality of care, doing thingslaparoscopically and in an outpatient setting.

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More providers are realizing that if they can be more efficientand get paid appropriately, they get better at their job, whichincreases their quality. They can make far more money in thatmodel.

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And brokers moving toward a more transparent fee model arehaving success, because if you’re tying your compensation to yourability to get results, not only does that put a whole lot ofpressure on you to get results, but it also justifies the amount ofmoney you get paid.

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PW: What aspects of data and technology are you mostexcited about?

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We track medical claims data and pharmacy and now have littleindicators in our reports that tells us if a member has filled fourdifferent prescriptions with four different providers in a certainperiod of time. That’s generally our red flag for potential opioidabuse.

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Pharmaceuticals are a big spend for health care, and if we canidentify where some of the abuse is happening and can identifysolutions for it, we’ll be able to make a big impact.

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PW: How can the industry do a better job of attractingmore women and diverse, innovative consultants?

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It’s a matter of engagement. I am constantly looking foropportunities to learn from everyone I meet, whether they’ve beendoing this for a year or 25 years. I probably learn more from folkswho are stepping into the industry and have a different perspectiveon health care now than people who have been doing this for 30years and may be stuck in a rut.

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There are more women like Rhea Campbell and Rachel Miner who arewilling to speak up, even knowing it does come with a small degreeof criticism on the back end. Those of us who do speak up encouragethe quieter women to do the same.

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PW: What are your sources of inspiration andinnovation?

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I’ve found that if I have a frustrating day at work and need anescape, I can usually hash out most of it lifting weights at thegym. I also write quite a bit about my thoughts and feelings on theindustry.

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There are people I really look up to in the industry, like DavidContorno, Kevin Trokey, Keith Wallace with Rice Insurance inWashington and Jolene Bryant who works at the Wilson Agency up inAlaska.

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PW: What are your favorite things about yourjob?

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It’s definitely not plan documents and contracts! I really likethat every single client I come across is different. I have clientsfrom 150 lives all the way up to 7,500 lives. They’re allself-funded, but that’s really the only thing they have in common.That requires so much puzzling and strategizing and that’s, by far,my favorite part of the job.

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

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Being open-minded, willing to learn and open to collaboratingwith your peers.

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Paul Wilson

Paul Wilson is the editor-in-chief of BenefitsPRO Magazine and BenefitsPRO.com. He has covered the insurance industry for more than a decade, including stints at Retirement Advisor Magazine and ProducersWeb.