The broker and doctor crossroad is a necessary intersection

Most benefit advisers are considered experts in navigating the complex world of employee health benefits and dealing with group health insurance. Most health providers, including doctors, nurses and other professionals, are great at focusing on their initial calling — which is helping people feel better. 

But how often do the two groups intersect in a meaningful way? Far too often, all of these practitioners operate in their own silo with unaligned interests that can lead to gaps in care. With so much perversity still baked into the system, it has never been more necessary than ever before for producers and healthcare professionals to develop a more symbiotic relationship on behalf of patients. 

In fact, it was a key theme of the second annual YOU Powered Symposium that I attended earlier in the year, where brokers and doctors shared direct primary care strategies at a pre-conference session. Several keynote speakers and workshop presenters also echoed the importance of building on this cooperation. 

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I'm in the enviable position of having belonged to both groups. Never during my time in nursing school did I remember someone talking to me about the administrative piece that came with caring for patients. The only time I'd dive into this issue was when we would get denials from our social workers to move forward with care. There were times I'd struggle to find the words to tell a terminally ill patient, "sorry, you have no insurance" or "insurance won't cover it due to your illness stage." It's not the easiest conversation to have with someone. 

Doctors walk into a room and fill the patient with hope, offering solutions that can sometimes be out of their financial reach. And this is where the necessary intersection of these two key stakeholders must happen. 

I am thankful for my nursing background and ability to pick up the phone and call a practice, or sit it on a peer-to-peer review and bring value to the conversation from a broker's perspective. I actually see the employee or claimant. I know more than what the write-up or pre-auth may have on there. I wish this could happen more times than not. I am glad to see more and more insurance carriers hiring physicians as part of their leadership teams because it will provide the necessary balance we need. 

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As a broker, I look forward to helping continue to bridge the gap between health insurance and health practitioners. Unfortunately, a physician now needs to not only help people in a physical way, but also be an advocate on the operational side. They can benefit immensely from our help, while it also helps to know their concerns in order to better serve our clients.

The goal of a collaboration between benefit brokers or advisers and health practitioners is to improve outcomes by ensuring that patients receive timely and appropriate care. Overall, this collaboration is a winning formula for everyone involved. Here's why: when health practitioners are better informed about their patient's insurance coverage and treatment options, patients receive better care. And with better care will come lower expenses. 

This, in turn, enables brokers or advisers to provide more value to their clients when they help plan participants navigate the complex world of employer-provided health benefits and the nuances of health insurance coverage. 

As the healthcare industry continues to evolve and the increasing focus on value-based purchasing is fine-tuned, this collaboration will become even more important in ensuring that patients receive the best possible care and that healthcare costs remain under control.