Drew Leatherberry, founder and advisor, Avergent, is passionate about transparency and transformation in health care pricing and delivery for the long-term sustainability of employer health plans.

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

I started 11 years ago, coming from the startup technology world, where I met a gentleman who had been in this business for 20+ years. He provided my previous company with office space, and we would have lunch and happy hour conversations about health care. When my startup dissolved, I co-founded a health insurance agency with him and we ran it for about four and a half years, working with small and mid-sized companies in Northeast Wisconsin.

We developed a care advocacy program to help employees make decisions when they got to that mid-level of care—an MRI, a CT scan or an orthopedic procedure—and try to steer them toward value. We tried to help people navigate their care pathways.

Related: Ask the (health care) concierge

When the ACA hit, it became more difficult to serve some aspects of the plan. In 2013, I decided to sell the agency and latch onto a larger regional agency in Green Bay. For the next five and a half years, I was one of their core producers and ran the business development team. Then, about two and half years ago, I started having an ethical dilemma. I got into this business to make a difference for employers, understanding health care costs were a huge expense for most businesses. But even though we were doing some innovative things around wellness and we had a near-site clinic, we weren't making a dent in the year-over-year trend. I learned about Health Rosetta, and David Contorno and I were both introduced to a mutual prospect at the time. I found out who I was competing against and decided I was not going to win that one. I reached out and congratulated him, and he actually proposed that we co-advise the client, which was completely new to me, but we were able to make it work. My eyes were really opened up to different possibilities.

The agency I was working for at the time was fairly traditional, and I decided at the end of 2018 that it was time to move on. I founded my agency, Avergent, on the idea that employers need to diverge from the status quo. We focus on bringing awareness and cultivating and educating employers about the opportunities that exist for them to control the cost and provide better quality care and more sustainability from a cost standpoint, as well as a better member experience.

In the last year, I'm happy to say our agency has really taken off. We've pulled in over a dozen accounts all around Wisconsin and we have employers who are seeing some dramatic cost savings.

PW: How has your career path and these experiences helped shape your current perspective and priorities as a broker?

Having worked for multiple start-up companies and being an entrepreneur by nature, I've had to make challenging financial decisions for myself and my family. That has given me a very personal view on the cost of health care. Because of that, I have a high level of empathy when I'm asking people to do certain things or telling them their deductible is going to go up. The data supports that Americans have been handing their pay increases, and then some, back to health care for some time. We've seen out of pocket costs for member plans jump to levels that are really unaffordable. I often use the term "functionally uninsured" when I talk to people about their health insurance. It's personal for me.

PW: How are you adapting to COVID-19? How has it changed the way you do business?

We've actually seen the benefits of having to change our communication frequency. We've been communicating with clients on a nearly weekly basis and in some cases, multiple times a week. Moving to virtual communication has actually created much tighter communication timeframes. In the past, we sometimes saved communicating with clients until we had the opportunity to go in and meet with them. We now see we can actually save the time it was taking us to travel and set up on-site meetings; now we can have more frequent communications that are more pointed. That has been a silver lining from all of this; I think it's going to set a new standard for us.

The other element is with fewer claims flowing through the system, it has given us a chance to take a step back and look at internal processes and consider some of the ways in which we engage our clients. It has provided an opportunity to enhance some of the solutions we bring to our members.

PW: How do you see this pandemic changing health care and benefits? How will it impact the way you plan and work with clients going forward?

We were already moving to create better virtual health interactions with providers, and this puts a big exclamation mark behind that move. I've talked to people on all sides of the health care world, from providers and carriers to employers and patients, and I think virtual interactions will be not only the norm, but might actually become the requirement and the standard.

From a perspective of access to care, there has been very obvious data that supports the need and importance of ambulatory surgery centers for elective procedures due to cost and quality benefits, but now we see additional benefits from the perspective of preventing the spread of disease. I would imagine they will only continue to grow in utilization.

I also think there will be a tighter lens on fraud. We're already seeing cases of misaligned incentives around diagnosing patients with COVID-19. Some appropriate protocols weren't in place and hopefully, this will illuminate the broader discussion around fraud, which is certainly something the health care world needs to address.

PW: What are the best things about being a proponent for change in the industry? What are the biggest challenges?

Brokers are often not at the front end of innovation; they've typically been reliant on the insurance carriers to drive change. The positive of being in a community like Health Rosetta is that advisors are really stepping into the lane of program design and asking questions that aren't usually asked about plans. From a proactive standpoint, that's a huge positive. I can tell you there's a number of initiatives that I'm involved with now that create opportunities to make a significant impact on the cost and delivery of care. That's really exciting, because it allows people to see the outcome of their efforts, whereas in the past, the traditional broker really felt like they were reacting all the time.

One of the challenges is there's a lot of skeptics and detractors, not only from the broker community but from carriers and the health care status quo. When we wake up in the morning, there are 3.6 trillion reasons we're going to meet resistance. The industry has a strong lobby. I hadn't realized how much of a habit skepticism had become for me as a broker. It gets easy to find reasons why something won't work, and that's a terrible view. If you have a bunch of people who are supposed to be architects for health plans who are disillusioned and skeptical, how are we going to move forward and create a new normal? There are a lot of people who want to tell you why things won't work, who have financial reasons to fight against transparency, or price equity.

We wouldn't accept this anywhere else, but we're at the point where not only is it allowed, but those who argue it should be different are considered illogical.

PW: Are there any particular challenges or opportunities unique to your part of the country?

It's always tough to answer this type of question without first qualifying it by noting that our health care professionals are very good in this region. But, we are heavily systematized. Independent clinics and physicians are nearly non-existent in this state, and that makes it very difficult. The corporate powers control the price and flow of health care, and a lot has to do with health care systems being aligned with the major carriers.

We talk about recreating the relationship between the payer and the provider and disintermediating and trying to remove all the fluff and waste and abuse out of the middle of the supply chain, but it's very difficult to do that here because we have a lot of entrenched financial interests. Health care systems own the majority of hospitals in the major metropolitan areas; we have primary care physicians that are almost entirely owned by health care systems. We have a lot of consolidation and health care systems that own their own insurance plans. It's very difficult for employers in our region to get through those alignments of financial incentives.

PW: This industry has long been seen as stodgy and reluctant to change. Do you see that changing? If so, how can we keep that momentum going?

We all tend to become more realistic over time, but I can honestly say I've never been more optimistic, because I'm seeing a different response from the employer community. Maybe it's that they've reached a breaking point financially; maybe it's that they understand they can no longer just react and need to be more proactive. Or maybe it's that some in the advisor community are starting to bring actionable ideas to the table that have meaningful impact.

You typically think it's the innovative employers that are moving the needle, but some interesting things have started to happen in my place in the world. I have clients who are fantastic innovators and not afraid to try things to move the needle, but a couple of clients have followed suit that I wouldn't classify as innovators. I feel like we're moving into the early adopter and maybe even the early majority phase from an employer standpoint, where people are making decisions differently.

When you think of tipping points, you need to be pushing toward the point where it becomes more normative for people to adopt strategies. That's why I'm optimistic; I think we're there. We have enough momentum in the advisor community to no longer accept the status quo and technology is allowing different care delivery models and financial incentive models. You have providers who are saying, "Enough is enough" in terms of being at the back of the decision tree regarding price and delivery of care. They want to work directly with employers. Things are going to change one way or another. Our alternatives are for employers to take the wheel or we're going to move to some form of Medicare for All or government-driven plans. I'm optimistic that employers will take the steps they need to take.

PW: What are your favorite things about your job?

What's exciting for me is that it's a frontier-type environment; there's a lot of really great things going on, and if you want to be part of it, you can. Innovation and the opportunity to shape what the future will look like has never been closer for someone who wants to be part of it as an advisor.

Of anything we consume, health care is where we are least able to make a consumer decision. It's an emotional time and it often happens reactively; there's complexity about the price and how it's paid for, so it's natural that abuses happen. It's exciting to get up in the morning and think, "I can make a real difference that's meaningful in helping protect people financially."

PW: Where do you look for inspiration when you need it?

I have four kids, ages 2 to 10. They are a great inspiration and have been part of my entrepreneurial journey. I'm very open with them. We talk about what running and owning a business looks like and "What does Dad do?" I get recharged when they ask questions like, "What are you doing with your clients?" It's almost a therapeutic effort of distilling something that's very complicated down to a very simple, easy to understand point. It helps.

I also love reading on lots of different topics. It always re-centers me. And I don't know how, but over the past few years, I became a marathon runner. I like to stay active and I try to keep fitness at the forefront.

I'm also really into mentorship, so I participate with our local chapter of Big Brothers Big Sisters and support that agency with one-on-one mentoring. I also have several business and personal mentors who I meet with regularly—virtually, as of late. I love those conversations; there's an old proverb that says, "Iron sharpens iron, and so one man sharpens another." To me, that's why I engage in mentorship; it's the ability to have someone challenge you, peer into your life and give you a different perspective.

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

Perseverance. In my company's development, we have seven core value behaviors. One of them is "embrace skinned knees." Everyone is going to fall down, but it's about getting back up and learning from the experience. Embrace the failure and realize it's the key to success.

Read more from our Face of Change series: 

• Leave a legacy: A Q&A with Chelsea Whalley
• Don't run and hide: A Q&A with Danny O'Connell
• This is a renaissance: A Q&A with Lindsay Clarke Youngwerth