As benefits advisors, does it often seem easiest to just renew your client with the health plan they had last year? What if the rising cost of doing this has eroded participation so much it is starting to become embarrassing? Let's face it, it's hard for an employer to prove their company health plan strategy is successful when only a small percentage of their employees choose to participate — regardless of the reasons they opt out.
When participation is low, it's hard for an employer to feel good, especially if they need to explain away their health plan shortcomings when they are hiring. It's tiring to continually explain why half of their employees "didn't want health insurance," or "chose to use their spouse's insurance." Everyone knows the real answer is that the plan offered was simply too expensive and/or didn't provide value for what the employer could afford to subsidize and employees could afford to pay.
Understand your clients' other problems, and help them find the money
What if you understood your clients' business ecosystems and their business issues even better? You could then help them holistically figure out how to find the money to pay for the health plan you know would be best for them. As a benefits advisor, there is immense value in showing a client how the health plans you provide can help lessen the burden of other business expenses.
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When there is so much competition for good workers, the real costs of recruiting and hiring creates more strain on employers. The pressure of keeping wages higher to retain top talent means that extra expenses are rising.
The advisor who can talk strategically about redirecting excess budget spent on recruiting, turnover and other expenses steadily gains advantage in the marketplace. After they've provided a health plan strategy and solution that their clients can actually use to recruit and retain the best talent, they can even show them how to have an ROI on the health plan they helped them put in place.
Lower prices are non-negotiable
We all know the problems we must address today more than ever are price and affordability. Advisors who are best at attacking these problems know that traditional, fully-insured policies are losing ground and won't work much longer – at least not if success is judged by high participation that curbs recruiting and turnover costs.
Getting smaller employers on ERISA self-insured platforms seems to be the only way to successfully address rising prices. However, it will always be necessary to re-risk the plan sufficiently with strategic designs and cost containment mechanisms. While a larger company can tolerate being slower to adopt the newer innovations around direct primary care, population health, and care navigation, it's non-negotiable for a small or medium-sized company if they want to compete and be safe.
Here are two tips that strategic advisors are finding useful for keeping their clients' health plan prices low enough so most employees can afford to participate.
- Split the plan into two parts and allow them to be purchased separately so every employee has an affordable choice (or even free in many cases). The first part should cover everyday services most users need, like primary care (virtual-first and in-office hybrid), labs, x-rays, generic Rx, annual physicals, well-baby checks, and chiropractic. These are quite inexpensive and can be given to every employee with no copay and little effect on plan costs. The second part is for the traditionally expensive specialists, advanced imaging, and hospital services. Separate these parts and participation will go up.
- Remove the extremely expensive (but rare) services from the primary health plan and have them covered another way. Inclusion of dialysis, specialty Rx, skilled nursing and organ transplants in a health plan will subject it to a lot of uncertain risk, so take them out of the primary plan and find another way to pay for these items when they are needed. Advisors who successfully make these changes are using supplemental plans or self-administered health reimbursement arrangements (HRAs) to cover these expenses.
Get bang for the buck
First, you've helped your client free up funds spent on recruiting and turnover, and you've also structured their plan for low prices every employee can afford so participation can be high. Now is the time to guide them to the employer contribution strategy that will benefit them most. It starts with the mindset that believes each dollar an employer contributes should create value for the business, not just become an expense. Employers get this, even if they can't believe it yet.
So, what is the big business challenge your client is facing today? Help them strategically direct their contribution dollars towards this and they will notice you. For example, if manager recruitment advantages would help a company, then do a management carveout, contribute more and include dependents to widen the candidate pool. Don't be afraid to think outside of the box.
Many advisors are using this way of creating health plans to lessen clients' work comp costs as well. When done right, they can actually pay for most or even all their health plans with these savings.
By shifting a client's perspective — helping them look at health benefits as a workforce investment, not just a hit to the bottom line — benefits advisors can become a trusted partner to their clients and win more business. You don't need to solve every problem but widening your lens a bit can be the difference that gets noticed. As your clients' businesses flourish, so will you, and more employees will get the care they otherwise did not think was available.
Dr. David Berg is the CEO and Co-Founder of Redirect Health.
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