Slide of creative benefit design transition model Brokers today are moving away from a single pointsolution for health care to menu of solutions that, hopefully,provide a better experience at a lower cost. (Photo: EmilyPayne/ALM)

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Brokers talk a lot today about cutting ties with the carriers.What does that mean? It means they're not selling a single pointsolution to cover all of an employer's health care needs. Instead,they're selling a menu of solutions that, hopefully, provide abetter experience at a lower cost than a traditional healthplan.

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“When you think about the term 'creative plan design,' our mindsautomatically and historically go to deductible, copay, network,”Josh Butler of Butler Benefits and Consulting explained toattendees of a session at the recent BenefitsPRO Broker Expo. “Health care is notthe same as health insurance. At the end of the day, if you askpeople what they really want, they want health care. They wanttransparent, good quality, fairly priced. You don't necessarilyneed health insurance.”

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Butler was a panelist for the session, “How to help employersreduce costs and improve outcomes with creative plan designs.” Hewas joined by Bret Brummitt of AG Insurance Agencies andRachel Miner of Thrive Benefits, and hosting the discussion wasQ4i's Wendy Keneipp.

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Setting the stage for their discussion, Keneipp described thejourney that many brokers and their clients are taking from fullyinsured to self-insured: “We start out at the far end, fullyinsured plans. From there, we look at how can we help our clientswho are not yet ready to make a bigger move and gradually move themover time into something that is a little more sophisticated andhelp employees become more engaged in the plan. From there we moveto a self-insured chassis. It allows you to create a traditionalself-insured plan or deconstruct it and bring in each of theindividual pieces you want.”

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Sounds daunting, doesn't it? That's because it is. There arenumerous obstacles to overcome. Thankfully, Brummitt, Butler andMiner were willing to share the obstacles they've encountered (oras many as they could cover in 45 minutes) and how to overcomethem.

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Obstacle 1: The employer

“Change can be beautiful, change can be painful. Most of thetime it's both.” This is how Miner starts conversations aboutimplementing a new plan design, hitting on the crux of the issuefor everyone involved. Employers, though they may not like seeingtheir health care expenses rising year after year, would oftenrather stick with the devil they know than take a risk on somethingnew.

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Like anything else, though, the right incentive will help opentheir mind. “You're taking something that's not the norm, and toexecute well, you have to have some kind of reward in it,” Brummittsaid. “Some kind of financial component or ROI to get the employerto buy in. I have to show some kind of reward to the employer fromthe cost standpoint.”

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Focusing on cost savings will certainly warm them to new ideas,but beware of choking the flame before it can grow. “A huge pitfallfor us and anyone out there: doing too much too fast,” Butlercautioned. “You're so excited to get in there and tell them everysolution you have, and you throw it up on the table. But we'vespent the better part of two years learning value-based insurancedesign. These clients we have are discussing benefits an hour and ahalf once a year.”

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Getting a feel for what a company wants to accomplish and theirappetite for change will put everyone on the same page and helpguide the process. “I always ask companies what is the goal of theplan?” Miner said. “Do they want to have cost savings, controlcosts for employees, an enhanced plan for next year? We can do itall at once, we can do it slowly. I look at the company culture andsee how they can adopt it.”

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Rachel Miner, Josh Butler, Bret Brummitt and Wendy Keneipp discussing creative plan design at the BenefitsPRO Broker Expo. Rachel Miner, Josh Butler, BretBrummitt and Wendy Keneipp discussing creative plan design at theBenefitsPRO Broker Expo.

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Obstacle 2: The employees

No creative plan design will work if it doesn't have employeebuy-in. “The employee has to be the one to execute the plan designstructure,” Brummitt said. “Any good design will fail if it's putinto the hands of someone who doesn't share that central goal.”

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That said, there is one key ally who can make or break thesuccess of any new solution: the HR department. “We hear, you justhave to talk to the C-Suite, forget the HR person,” Miner said.“But the HR person is going to be the one dealing with the employeewho comes in crying because their child can't afford to go see aneurologist.”

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Listen to and address the concerns of the HR department, andthen ask for their help in crafting the right communicationstrategy for employees. “You hear a lot about education,” Butlersaid. “One mistake we often make: We're very eager to go andimplement solutions, but we haven't got a well-thought-outcommunication strategy.” Butler stresses the need to make benefitseducation and communication a year-round process, not justsomething done during open enrollment.

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But how do you get employees to actually listen to the message?Brummitt has an interesting tactic: his fictitious mystery boil. “Itake this ridiculous thing and put it into a real life situation,”he explained. “My mystery boil goes to the doctor's office. Mymystery boil gets sent off to the labs, goes to CVS pharmacy fortreatment. I use this cartoonish feature to sink that earworm intothe communications piece.”

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Also effective is hitting on that key issue of what's in it forthe employees. “I talk to employees about how they do not want tobe paying their maximum out-of-pocket,” Miner said, adding that sheoften shares the story of her own health care journey and the resultingexpenses. “I've had four years in a row where I've hit my maxout-of-pocket. It's not fun. People buy from people they like. It'sthe same thing; we're selling the changes to the employees. If Ican say, 'I've been in your shoes, this is why I want to help you,'it resonates with people.”

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Obstacle 3: The vendors

One of the hardest, or most time consuming parts of building aplan from the ground up is the influx of new vendors offeringproduct solutions with which to build those plans. ”It's hard toknow from the solution provider to sales pitch to end result wherethat path works the way it's supposed to and where it may not,”Brummitt said. “And do you even understand what someone's sellingyou? Some of these things are not even easy to understand from theget-go.”

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Miner offered her checklist for working with new vendors: createan RFP process, require references, ask for a performanceguarantee, and look for overlaps with current vendors. It's vitalto thoroughly vet any new products before recommending them,Brummitt agreed, both by talking with happy and unhappy clients aswell as getting feedback from a peer group. “Without that, you'replaying learning lab with your client-employees' lives,” he said.“That's not a fair thing.”

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And remember, as the consultant who recommended the vendors,you're also going to be the face of any problems the employerfaces. “I did not, at that point in time, understand the value ofthat vendor becoming the face of the problem or the service,”Brummitt said, recalling one particularly bad experience. “It wasstill pushed back on me. I did not make the proper introduction orhandoff. When you take something from a boxed solution tounbundled, there's a different level of service providerexperience… you can't be the face of something you can't fix.”

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As a final note, consider the reaction your employer client willhave when you show them the new list of vendors and productsreplacing their traditional health care plan. “You can show savingsin the plan, but a lot of time it gets overlooked,” Butler said.“Even if they are still overall saving money, if it makes theadministrative process a lot harder and they feel like they'regetting nickel and dimed, that needs to be addressed. Streamline itto make it an easy, single point billing.”

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Emily Payne

Emily Payne is director, content analytics for ALM's Business & Finance Markets and former managing editor for BenefitsPRO. A Wisconsin native, she has spent the past decade writing and editing for various athletic and fitness publications. She holds an English degree and Business certificate from the University of Wisconsin.