Employers and employees are preparing for significant changes in the benefits landscape in the coming years. Our "Town Hall' session will delve into new and innovative trends in medical funding and explore key benefits topics such as reproductive rights, anti-DEI measures impacting workplace inclusivity, student debt, and other financial concerns affecting both employers' and employees' bottom lines. Our interactive format encourages attendees to engage directly with our experts through live Q&A. So come prepared with hard-hitting questions and get ready for candid, off-the-cuff answers. Join us to understand what to expect in 2025 and beyond, and how to navigate and leverage these advancements effectively.
Transcription:
Eric Silverman (00:09):
I want some crazy off the wall hair, brain, insane questions. Your thoughts on what's going to happen in 2025 predictions and so forth. You can even, of course throw in fourth quarter 2024. Okay, so I'm going to kick it off with a softball question for these guys and then we're going to open it up. We're going to have a few folks roaming around the room with microphones, so please get your question ready. Generic, just very bland and generic softball question. I'll start with Erika. What trends do you see starting or picking up in 2025 with employer-based plans?
Erika Ensign (00:52):
So we've talked about this a lot this week. I think what we're finding, the conversations are migrating or transitioning from the typical medical, dental, or vision to other benefits that make up a whole person or other needs that really just don't fit in that box anymore. I hate to say outside of the box, that seems really cliche, but we're finding that there's so many other things that people need in this world and we as advisors, we're in a really unique position where we get to go out and find those things and bring it to the table because our employer groups don't know what they don't know, but they do want to help their people. So they're like, what's out there for our people? That's what I'm finding,
Eric Silverman (01:42):
David.
David Contorno (01:43):
So I have a radical prediction for 2025 costs will go up and benefits will go down. I know that that might be a little surprising but shocking. I've been doing this. Tell me more. I've been doing this for almost 31 years and I remember when individual premiums were approaching a hundred dollars a month and family premiums were approaching a thousand dollars a month, and I said it can't go on any longer. But my real answer to that question, unfortunately, is one that some of us have been doing for half a decade or a decade at things like unbundling, getting the carriers out of the way, who contractually preordained you and your employees to paying the highest price in healthcare, to inserting all these middlemen that add to cost and add to commissions and add to money going out the door that don't actually go to care.
(02:28):
Those solutions exist today. And so what I hope happens is the trend continues that employers stop intermingling the words healthcare and health insurance, understand that they're two separate things and say, I'm going to make sure my employees and their families get the best healthcare possible, but I don't need the traditional systems that have ensure costs go up and benefits go down every single year. I mean, does anyone in this room think that that's going to change in 2025? It hasn't in my 30 years. So we got to look for different solutions because literally the definition of insanity applies to what a lot of us live in, more so than I think any other sector of the economy.
Eric Silverman (03:07):
Alright, let's open it up for some questions. Who wants to kick us off with a question? Got Mike's coming around the room. Don't be shy, everybody, don't be shy. There we go. Back left. Thank you.
Audience Member Morgan (03:19):
Morgan. Hold on.
Eric Silverman (03:20):
Perfect. Thank you, Morgan.
Audience Member Morgan (03:23):
A quick question, dealing with the different benefit packages that we have and the different generations within a company, how can you effectively and successfully implement benefit packages that hit each generation, not just the baby boomers, not just those lovely Gen Z folks or myself as a geriatric millennial? How do you actually implement those good programs that do hit each generation and effectively help them? Basically,
David Contorno (03:54):
You go first.
Erika Ensign (03:55):
Okay. I don't think there's an easy button or a magic button. I think that as different as the generations are, I think the communication also has to be different and also their packages. So I think that while you can make a comprehensive benefit package, you have to figure out a way to systematically communicate it to those people in a way that simplifies it. I mean, it goes back to the kiss, right? Keep it simple, stupid, right? And David mentioned it earlier, Emma's mentioned it in the previous session of the difference between healthcare and health insurance. People need access to care. The care that that individual needs is different from each person and what they value. So the people who are sitting at the table making those decisions see healthcare different than maybe someone out in the field with different demographics. And so I don't know if I'm effectively answering your question, but it's a lot of different type of communication tools, a lot of benefit packages with different types of benefits.
Eric Silverman (05:07):
Just real quick, the question was basically so many different generations in the workforce, how do we do that with respect to benefits in all aspects, David?
David Contorno (05:17):
So I'd argue there's two reasons why you can't right now. The first is if you're in a carrier based environment, they don't let set the rules around. I mean, they talked about customization of healthcare, but when you're applying the same PRECERT rules and the same drug formulary to an entire population, how are you customizing care? So problem number one is the carriers don't let you. Problem number two, and I think this is the biggest obstacle, you can't afford it, how many millennials would love a $10,000 infertility benefit, but no employer when they're stretching their high deductible health plan and they're barely able to afford a 6,000, 12,000 out of pocket, where are they going to find the resources to put in infertility benefits, to put in financial wellness, to put in enhanced mental health care? The resources don't exist. And so what I would argue is if you find the right consultant who can reduce your second or third biggest line item by 30, 40, 50, or 60%, well now you freed up the resources in order to customize the programs.
(06:11):
And you know how you find out, ask with our clients when we've delivered savings after a couple of years, we put out a survey and we have one client of about 4,000 employees. The number one benefit they wanted that they didn't have was a massage benefit. And so of these 10,000 bodies, every single person on the plan gets a no-cost massage every month. And that was a tiny little pittance of their healthcare savings. So that's the biggest obstacle I think is affordability. And if you can figure out that problem, then customizing a plan to all different generations within a population is easy. Oh, this table.
Eric Silverman (06:51):
How about Stephanie here in the front?
Audience Member Stephanie (06:53):
I think at my own question. Sorry. Okay. So I'm fortunate to have been in what I consider the non-traditional healthcare space since 2016. We don't work with the BUCAs anymore, and we've seen not only tremendous savings for our healthcare spend, but we've also been able to improve the benefits for our employees and their family members. Keep the premiums flat. But for those people in the audience that are not there yet, what questions could or should they be asking their benefit advisors that are often overlooked? Because sometimes what I have heard is HR professionals, and I was one of them, they get comfortable with the broker or advisor they're working with because it's the CEO's golf buddy or brother or, oh, we've been with them for so long. How do they make that change? And what question should they be asking their current broker to see if they're even the right fit for them anymore?
Erika Ensign (07:58):
I'll go first.
(07:58):
You can go first. Yeah.
David Contorno (07:59):
Well,
Erika Ensign (08:00):
It's a low
Eric Silverman (08:01):
Gentlemen first.
David Contorno (08:02):
I think the first thing is, and I know that Jessica Brooks Woods brought this up when she spoke, but there's a law that requires brokers to disclose their compensation. I speak with, I don't know, 10 to 15 employers a week. I have yet to meet one that got a compliant disclosure from their employer. So I think the first question is how are you paid as a broker? What influences how much money you make off of my company? That's question number one. But that question then needs to extend to every vendor within the space. And if any contract, and I don't care what their marketing piece says, I don't care what the sales person from the PBM says, what does the contract say? There was a big lawsuit against Express Scripts. The town of Rockford, Illinois sued Express Scripts. This was 10 years ago maybe, because this little drug called HP Act qar, which has been around for decades and decades and is used to soften the wall of a pregnant woman, was $40 because there were two on the formulary. And Express Scripts decided to remove one from the formulary, which actually caused the manufacturer that to go out of business. So it became a single source generic, and the price of that vial went from $40 to about $20,000 within a few months. And the city of Rockford, Illinois sued Express Scripts for breaching their fiduciary responsibility for lowering drug costs. And you know what Express Scripts said, show us in the contract where we're required to lower drug costs.
(09:33):
That's the truth of it. But their marketing says otherwise, anybody who's been pitched by any of the big PBMs, we're going to save you money. We're going to lower your costs. But that's not what's in their contract. And when they make more money, the more drugs are filled. When they make more money, the more expensive the drugs are filled. That's the results you're going to get.
Eric Silverman (09:50):
Erika, any on that?
Erika Ensign (09:54):
So for us, I actually had this conversation this morning because in our shop we also do commercial insurance too. So I love our commercial folks and I'm licensed in both. And so I get these calls of, Erika, you need to talk to these guys. They want to talk about health insurance. And so I thought, okay, I call the head of the HR department and she's like, I was like, yeah, well why don't you just, I wasn't in the conversation, so why don't you tell me what you and Philip talked about? And she's like, yeah, we're just kind of trying to figure out, maybe we're going to shop around. And I was like, cool. That's exactly what I was waiting to hear. And I said, oh, okay, great. Well, I said, well, I'm not really sure if you know the difference of commercial versus benefits, but unless your demographic census that you send to me is different, or we're asking for different types of commission or so forth, we're going to get the same things if we're going to the same markets.
(11:00):
So ultimately, my question to you is what are we trying to accomplish? And so I think that as an employer, that's what I asked her. What are we trying to do? I understand that you want to have the lowest cost. Cost is always a component, but sometimes it's not always the highest component. I do a lot of fire districts in Texas, and so ironically enough, there's all this money that's being infused into Texas because people are moving into Texas. So taxes were going up, and these fire districts are like, we have all this money and now they're spending all these. And I'm like, okay, but you're supposed to be able fiduciary responsibilities of spending it wisely. They don't know what they don't know. And so I said, you really need to find a partner that's going to help you. We're using coverages or certain things for your folks as a vehicle for attraction and retention for your population. It could be medical, dental and vision, it could be disability, it could be whatever. But how can I help you? Because if you're just wanting me to go wash, rinse, repeat what you have, I'm going to get the same damn thing.
Eric Silverman (12:10):
Yeah.
Erika Ensign (12:10):
And she's like, oh,
(12:12):
Okay. Well we have to present that to the board. I said, I would be happy to present that to the board. I've done it on a number of occasions because it's a lack of education. They don't know what they don't know. And y'all are, as an employer, your educated in your level, your job. And so you have to find those partners that, I mean, that's why we do what we do because we're supposed to be the experts to help you be informed of the things that you don't know, not because we're looking at you going, wow, you're such an idiot. It's like you're not responsible for knowing these things. We're here to help you and be a partner to you. So something as simple as this particular group is doing paper applications. Some of it is not as much as a cost. Is it administrative burden, right?
Eric Silverman (13:02):
Efficiency?
Erika Ensign (13:02):
Yeah, efficiencies, right? So it's like, okay, I'm sorry, you're doing, you have six different carriers and you're doing six different applications with the same information. It's redundancy. And now all those applications have the social security numbers of all your people on six different applications that you can't, oh, well, here's one on the ground that you forgot to give to me, an open enrollment. And so there's just a lot of different variables. And so it goes more than just the package. How do you streamline it, how do you communicate it, how do you keep up with it? It's a lot of private information, not even just claims, but they're socials and there's just so much information there that you have to figure out a way to systematically streamline it. And sometimes it's just a matter of, okay, what's the biggest pain point this year that we can help you with?
(13:53):
And what does that look like? And then put, and David's mentioned this in the many years we've known each other, you put a multi-year plan together, right? Let's just whiteboard this. How many problems do we have? If you had a magic wand and you could fix everything, let's go and just write it all down and then go, okay, what are the things that we could do this year that would move the needle the most and make the biggest impact for you? Alright, is this realistically something that we can do this year? And then we table the next one for the next year and so forth. Obviously each year is going to adjust as we go, but it creates that partnership of like, I'm in the trenches with you. I'm going to roll up my sleeves and get dirty and let's do this.
David Contorno (14:34):
And Erika reminded me of one thing that I wanted to say, and that is I'd like to apologize to any employer in this room because my industry has done you a massive disservice. What we've trained you to believe is that you can call in five different brokers, and we're all going to bring in the same plans and the same rates. It's just our spreadsheet might look a little different. And that was the first 18 years of my career. I hope to be the nicest, take the CFO out for golf, be the one to win the business on everything, but what it was they really needed me to do, which is make their healthcare higher quality and lower cost. And while a lot of people are still operating in that same environment, because frankly, it's what they know and it's easy. There are others out there who are working differently and therefore delivering different results. And like Emma said earlier, I started off by just taking the George Costanza approach, which is do the opposite. If you want the opposite results of what you're getting, do the opposite. Of course, it's a lot more systematic and well planned out now than it was initially, but that was what started this path for me anyway.
Eric Silverman (15:37):
You know what I heard between both of their responses? I dunno if everybody caught it, is really change and move the conversation completely away from costs, which is always where the conversation starts and where most professionals, even in this room, if you're really honest, where it typically ends. So I love how they're moving that conversation in a different direction.
Erika Ensign (15:55):
And speaking of opposite, as a female, I have the opposite things of the good old boys. So that's helpful to go in and go, yeah, I don't really give a crap. If you want to go golfing, that's cool. We can do happy hour, whatever. But I'm not here to be a relational issue for you because what you're getting right now is probably being funded by these elaborate things that you broker might be doing. You're funding it.
Eric Silverman (16:27):
Yeah, exactly. They're paying for the golf.
(16:29):
Just doesn't look it that way.
Erika Ensign (16:30):
No, no. They taking it. They're not taking you out.
Eric Silverman (16:33):
Taking yourself out.
Erika Ensign (16:33):
Yeah, that's right. And so I heard this a few years ago from a colleague of mine and she said, Erika, because I have always steered away from the sales, I'm a salesperson. I hate that for lots of personal reasons in my family life. But she said, there's typically two types of salespeople. It's that relational people, which in our industry still has that good old boy, like rubbing elbows and whatever. And then there's the strategy of I am here because I'm here to transform your program. I am here because I matter to you because I'm doing something helpful for you. If we're friends at the end of it, fantastic. That's great. That's a bonus. But I'm here because you need help and I can help you and let's just get this done.
Eric Silverman (17:29):
Emma, what's on your mind?
Audience Member Emma (17:31):
Hi everybody.
(17:34):
So with the price transparency data that came out, we very quickly figured out that network contracting is actually 2, 3, 4, 5, even 1200% higher than cash prices, Medicare reimbursements. And one of the things that's been sort of gaining popularity over the year, or certainly the last couple of years is direct contracting. But the biggest pushback that I get from employers is that you can only do that if you're big. You can only do that if you have leverage. But I'm seeing more and more of hospitals come to me and tell me that BUCAs are their worst payers, that it's the biggest headache, that it's the biggest runaround, and they're trying to figure out ways to directly engage with patients and employers. How are you advising midsize and smaller employers as to whether or not this is possible for them? I feel like a lot of the strategies we talk about, we're talking about big self-funded folks, but what if you're not that? What do you tell them them?
David Contorno (18:28):
Well, first of all, within our agency we aggregate these direct contracts. So we make them available to all of our clients. So we have a little bit more scale, but we're not working with 10,000, a hundred thousand employee companies. Most of our clients are a few hundred to a few thousand employees. So if you can aggregate it, that's great, but I think the more important answer to that is you have to get into the mind of the hospital, CFO, what are their pain points? I will tell you their pain points are the following. Carriers are taking longer and longer to pay. The more that a carrier pays out on a monthly basis across the country, the more interest they get by holding that money for several months. So some hospitals are waiting 180 days to get paid. Problem number two are all the hoops they have to jump through in order to get paid the pre-certification and the prior auth process.
(19:16):
And every day they get a new day approved, but getting another day approved if they're inpatient, all of that is an administrative hassle and a massive expense. But I think the third point, and maybe the hardest pain point for hospitals are these ballooning out-of-pockets and deductibles. And what you may or may not be aware of is that hospitals write off about 75% of patient responsibility. So think about this from a chain of events perspective, deductibles go up, hospitals write off more of that out of pocket. So they go to the carrier and say, we need a little bit larger increase in reimbursement rates to compensate for the fact that we're these higher deductibles and we're not getting paid on them. So the carrier willingly gives it to them because it's in the carrier's best interest to do that, as well as the hospitals. Now that higher reimbursement rate leads to what in the market?
(20:06):
Higher premiums. So what does that lead the average broker to do? Suggest an even higher deductible, which then has the hospital writing off more, asking for bigger reimbursement premiums going up, deductibles going up, and we're like, I feel like we've been circling the drain for two decades here on this problem. But the reality is, is that if you can go to a hospital CFO and say, I understand your pain points and I can solve them. So in our plans, we pay in 30 days. Contractually we pay a hundred percent. There's no patient responsibility. And as long as we have a pricing methodology that's not a discount off whatever they decide to charge, we'll pay them a hundred percent of what they built. And so now we've solved all of their problems, which means you are offering them a lower reimbursement rate on behalf of your client that allows them to be more profitable than they are on a higher reimbursement rate.
Eric Silverman (20:53):
What other questions do we have? Let's go in the back of the room please. Thank you. What's your name?
Audience Member Jen (21:01):
Hi, I'm Jen.
Eric Silverman (21:02):
Hi Jen. What you got?
Audience Member Jen (21:05):
So this is interesting, something that you're talking about made me think. So we have obviously, or we have employers, we have insurers, we have brokers. I'm curious about that relationship because it seems like there is a challenging relationship, particularly with the insurance component within there. So how do you see that evolving? How do you work with carriers? What is sort of the relationship there? Because you've said a couple of things that I thought, huh, interesting.
David Contorno (21:32):
Well, I'll go first, but I definitely want you to answer that we don't work with carriers. And I want you to know that was a very difficult switch to make. I was lucky enough to start to transition while owning a traditional agency, but I had millions and millions of dollars coming in from United and Blue Cross and Cigna, Aetna. And as I pushed this non-car based agenda that I knew was the right thing for my clients, I would have execs from these carriers fly in and say, David, if you keep pushing this agenda, we're going to cut your contract. And United alone, if they cut my contract, it would've been a massively different agency overnight than it was the day before. And so they would wield this threat. And so I know I'm in a very small group, but I wound up selling my agency to private equity.
(22:18):
I stayed on for a couple years, and when I restarted with my partner, we committed to never getting paid by anybody but the client because that's who you work for. I believe you work for whoever's cutting your paycheck, and if Cigna or Blue Cross is cutting your paycheck, you work for Cigna or Blue Cross. And I wanted to work for my clients, and not only do we do that, but we flip the commission model around to where we get a bonus tied to how much we lower costs. And Charlie Munger, for those of you who don't know, passed away last year he was Warren Buffett's business partner at Berkshire Hathaway, and he said a saying that I say all the time, if you show me the incentives of any system, I'll show you the outcomes, change the incentives. If you care about your employees and their families getting high quality care for a lower price, then make sure that all the entities within your plan benefit from higher quality care being delivered at a lower price. If it doesn't, I don't care what they say or what they promise, it's not going to happen.
Erika Ensign (23:14):
Mine's a little different. Now I do, I agree with David wholeheartedly, and I do have groups that operate like David's. I would love all of my groups to be in that. But what I do have is when we sit across the table from an employer, we'll use Louisiana for an example. I have clients out there too, and Blue Cross Blue Shield is like 85% of that entire state for 20 something years or whatever. They know that's what they know. I want the blue, I want the blue, and you can't tell me any other way. And if you do, you're wrong because I'm a business owner and I can't be wrong because I'm supposed to know everything and I'm on this pedestal and people think I know everything. So I can't lose this persona. I'm also a female telling this guy this, right? So I'm like, cool.
(24:17):
So I say all that to say we do work with the BUCAs because we have to meet our clients where they're at in that moment. Right now, I have clients that have been with Blue Cross Blue Shield or with Cigna or Edna or UnitedHealthcare. We're still having those conversations each year. Hey, by the way, there's these other things of unbundling and taking it. And right now I have a case that is with Blue Cross Blue Shield, Louisiana, and we put a self-funded prescription plan on top of it because this is going to be the third year we've been talking about self-funding and they just haven't pulled the trigger because behavior change, unbrainwashing, somebody takes a while.
(25:10):
And then you have to teach them in order to make something better, you have to break it apart and then rebuild it correctly. And that takes a while. And so you can only go with the pace that those people are comfortable moving. Sure. And so meeting those people where they're at, I tell 'em, I'm like, look, we work with them because I speak their language, but I work for you just as much as what David said. I work for you the employer. I am your partner. I just happen to know what the hell they're talking about.
(25:41):
And so I can help translate that for you. So while we work with them, I don't work for them, so I can help you. And if you believe that that vehicle this year is best for your organization and your employees, that's fine, but at least that's the bed that you're in this year. And you know that. And there's all these other things too, because even if there's choices, our employers just don't want to feel like they're backed into a corner. I have choices. I should be able to make choices. I don't want to feel forced into doing something. So if you provide them choices, they say, okay, well, I know you're telling me this, Erika, and I think that we probably will be better off here, but this feels comfortable right here. So I want to stay right here this year. Okay, that's fine. We're still going to have these other conversations over here. Well,
Eric Silverman (26:28):
Change is uncomfortable, right?
Erika Ensign (26:29):
It is uncomfortable even if it's for the better.
Eric Silverman (26:32):
Well, it sounds like what Erika is saying, and I love the approach, is crawl walk runs. So they're still with Blue Cross, right? In your example, and you are moving them to something going down the path that you want them to take. You're pushing them ever so slightly at their own pace to meet them where they're at. So I think in, let's bring it back around. And we saw plenty of time. Please get your questions going. Grab another glass of wine we got all night if you really want. Not really, but kind of maybe not at all. Heather's going to fire me. But this is all in the same vein of shaping the future, right? Looking at 20, 25 and beyond. So it sounds like that would be a way that what's going to continue in 2025 is crawl, walk, run, bringing them some different ideas so that you can meet them where they're at. Who else has a question? Please, by all means, Tiffany. I do.
Audience Member Tiffany Ryder (27:21):
Hi, I'm Tiffany Ryder. So David, I know that I've been building this fiduciary solution and we just had a whole hour I think, on fiduciary, but one of the things that we have sort of agreed upon in this industry it seems is that fiduciary responsibility is greater and the risk is greater and higher for the self-insured populations. But we don't really talk a lot about how it varies between using the traditional plans, traditional carriers. And I have a love hate relationship with Mark Cuban. I'm not sure if anyone else does, right? But he tweeted a few weeks ago and he said, if you're not using a pass through PBM, then it's not a matter of if you get sued, it's a matter of when. And so with that in mind, how do you think that going through these non-transparent BUCA carriers who essentially have a fiduciary duty to their shareholders and have no responsibility to the patient, which is a real problem for me as a clinician morally and ethically, but how do you think that that impacts the fiduciary best practices and responsibility for employers?
David Contorno (28:44):
Well, the first thing I want to point out is that there's not a set of fiduciary standards for fully insured that is different for self-funded. The fiduciary standard is the same regardless. What I would argue is actually being fully insured makes it harder for an employer to meet their fiduciary standard because they have less insight and they have less control than in even a BUCA based self-funded plan, but certainly an independent based one. But what the law says, ERISA doesn't say you have to follow the law to the letter of the law. What it actually says is you have to make a good faith effort now, a good faith effort for what a good faith effort to make sure that the money that's going into the plan is benefiting all participants equally. So if you take the ERISA law that applies to your 401k, we all know we can't put in our buddy's mutual fund into our corporate 401k because he's our buddy or she's our buddy, but it's worse performing.
(29:38):
We know we can't do that. Well, guess what? Not a similar law. The same law should be interpreted as saying, well, I can't put in a low quality high cost hospital into my network because if one employee goes to that low quality high cost hospital, every participant of the plan suffers. It's exactly the same. And so the issue is, in my opinion, and there's someone I know at that table who might be able to change this, there's no enforcement of ERISA on the health plan side. And it took a massive class action lawsuit for the law to be applied on the 401k side and had dramatic impacts on people's 401k results, performance and savings to the positive of the participant. So if you take that same philosophy, you take that same responsibility and say, how do I apply it in the health plan? Well, you can't be fully insured. You probably can't even be self-funded with a buca because you can't go in and say, I want to carve out this hospital. They're all, but you should be saying that. And if you do say that and you get the data to show that and you make a good faith effort to comply, then I believe that you've met your fiduciary responsibility.
Eric Silverman (30:48):
Other questions, don't be shy, everybody. I got one. What's the election in November going to do to any and all of what we've discussed this week?
(31:00):
How about that? You're welcome. I did it.
Erika Ensign (31:03):
Oh crap I forgot my crystal ball.
Eric Silverman (31:05):
Let's go. What election? Erika, you get to start with that one.
Erika Ensign (31:09):
Yeah, I don't have a really good position on this one. I think that David will have a much better and more eloquent way
Eric Silverman (31:20):
He's salivating right now. So you're just buying him time to get it all prepped.
(31:28):
Let me break it down, right? What's a constant that isn't going to change whether it's blue or red in the office? It's irrelevant. In what capacity is that?
Erika Ensign (31:36):
No, I think that at least for my employer groups, a lot of times when they get to the healthcare segment, they still are confused.
(31:50):
Still have no idea. They're like, I don't even know what this means for us. And then the election happens and then they're like, okay, and then what are we supposed to do now? Right? So take A CA for example, it's like that was passed and then it took for years for it to get enforced. And now we still have people that go, okay, and then what are we supposed to do again now? And reporting. I mean, I get employer groups that will get the IRS penalty back from tax year 2018. And I was like, oh, so hey, by the way, I wasn't your broker back then, but I can really help you. You did all the things. Just send the information over and it just magically goes away. By the way, they won't tell you like, okay, you did what you were supposed to do. Good job. They just go MIA.
(32:33):
So I think that I'm not really sure that I'm answering this question effectively. I just feel that whatever happens in this election, we will do what we do now. Right now we are navigating constant change, right? Monday, this is what it looks like, and then all of a sudden somebody wakes up and goes, well, shit, now Tuesday. No, I changed my mind. I don't want to do it that way. And then we're going, okay, great. So there's passing of laws and passing of things that happen, and then there's this time when you go, great, how are we going to enforce these folks to do these things? And then how is the penalty? And then is there a penalty? Right? I get that question a lot from my employers. Okay, I know it says I have to do this, and if I don't do it, it's bad, but what is it costing me? I mean, it's kind of like the pay or play scenario of like, oh, if the penalty is this, that's fine. We'll just screw it. We're just not going to do that because it's not worth us doing all of this other stuff that I have no idea what to do. And I'm like, okay, well at least now here it is.
Eric Silverman (33:44):
So before we let David out, let me just try your best play neutral in the sandbox. We're working together. He's good at go.
David Contorno (33:52):
I'm going. So if you don't follow me on LinkedIn, I encourage you to, but for those of you that it's
Eric Silverman (33:57):
A good show.
David Contorno (33:58):
I have evolved recently. I've been through my own medical and mental health journey this year that I shared pretty openly about, and I'm going to answer this as Tiffany says in the David 2.0 answer. So the answer from both sides of the aisle, if I could put it, Frank, is more of the same. Kamala Harris wants to expand the A CA. We already have the A CA. Trump wants to expand privatization of insurance. We already have privatization of insurance. And I will tell you, and I've worked with both administrations in some capacity, I can tell you that neither one of them understand the problem and they're not going to develop a solution to a problem they don't understand. At the end of the day, we need healthcare to cost less and deliver more value, and the private sector's not going to do that. It does the benefit them and their shareholders, the government's not going to do that because I don't know anything our government's taken over that's gotten better in quality and lower in cost ever.
(34:58):
The people that hold the most power are the ones that are wielding that power the least, and that is he or she who controls the purse strings, which is a combination of the employer and ultimately the patient. Now, I fly a lot for business, and I can't tell you I get upgraded to first class and I wind up sitting next to these way more successful, way smarter business people than me quite frequently. And I can't tell you that every time I get into a conversation about what I do, they say, oh, I recently had shoulder surgery, but I had the surgeon who does the Patriots, the Mets, the Packers, insert your local sports team here. And I'm like, wow, every orthopod must be working on every sports player, on every team because everybody has the best orthopedic surgeon. Nobody's asking the right questions. And so if we're not asking the right questions and we don't understand the problem, how are we ever going to develop a solution?
(35:50):
And back to that health insurance and healthcare, and Erika kind of alluded to it, so many employers put the decision on which broker to use or which carrier to go with or which plan to go with on the premiums. But that would be basing what car to buy solely based on what your Geico is going to cost and completely not care about the cost of the car or the quality of the car. And let's think about buying a car. Do we figure out the insurance first and then the car? No, we figure out the car first and then we deal with the insurance. That's the way healthcare needs to occur. We need to deal with the care first. How do I get the best outcomes or the most likely best outcomes at the least cost? Then I'll figure out how to finance it, but we do it completely backwards.
Eric Silverman (36:34):
I'm proud of you, my friend. Thank you. It's very smooth. We have time for another question. Maybe two. Don't be shy. Come on guys.
David Contorno (36:41):
That's the hard one. Come on.
Eric Silverman (36:43):
Something hard, something that makes them sweat a little bit. Anybody this room full of human resource professionals, what's on your mind for 2025? What are you most nervous about? It doesn't have to be benefits related. It could be communication, enrollment, engagement. It could be nonmedical. There's a lot out there we haven't discussed.
Audience Member 6 (37:03):
I'll ask question.
Eric Silverman (37:03):
Would you like to ask? Sure.
Audience Member 6 (37:04):
When is my GLP one going to cost less? There
David Contorno (37:07):
You go. Actually speak to Emma Fox about that because she knows how to do it.
Eric Silverman (37:14):
Love it.
Erika Ensign (37:16):
And we were talking about this at dinner last night, right? And I don't know if
Audience Member 6 (37:20):
And when are more people going to be able to have it that really need it.
David Contorno (37:23):
When employers demand that their employees get it. If you went to any carrier and said, I want GLP ones covered under my plan, I'm willing to pay for it. And they said, no, go to the next carrier and if no carrier will do it for you, then have someone custom build a plan in which that's covered. But Emma does a whole talk on it, and the way that we treat obesity and the way that we treat treatment for obesity is way different than we treat any other disease.
(37:46):
She has something to say.
Audience Member 6 (37:47):
Do you want to answer?
Audience Member Emma (37:48):
I'm not going to answer. The professionals are already up there, but I actually had a follow-up question, which is I want both of your guys' perspective starting with Erika actually is one of the challenging conversations I have with my clients is that a lot of the solutions that we bring that we know are effective, they still sound like gimmicks, right? Like direct primary care. Oh yeah, okay, that sounds great. But GLP ones, are they ever going to be covered? There's all of these arguments going on when you're having conversations with your clients about what will actually work, how do you convince them that these solutions are credible, that they're actually working? Because I feel like they only know what they know, and it's really hard to believe that there's something better out there when this is the only thing that they've been doing this whole time. So I'm just really curious, how do you talk to your clients about this stuff?
Erika Ensign (38:39):
Well, that's a really great question. So I'm going to answer it in two ways. One, I try to use as simplistic language as possible, right? You are a human. I am a human. I have children. You may or may not have children, spouses, whatever. I understand that this sounds ridiculous because this is completely opposite of everything you've ever heard in your entire freaking life. So what I do do is fortunately in this industry, I have been able to create a village of people like you and David and all over the country that has fought this fight for so long. So y'all have the blood, sweat, and tears and the scars from the stories that I can use in the decade plus that I've been doing this. I have been able to live through my own now in the gimmicks just freaking be real. I had, okay, for example, one of my fire districts we are using at this point, they've been self-funded for a while, but they still haven't removed the Aetna network off of their plant.
(40:08):
So they're still using the Aetna plan. We've been able to carve out pharmacy little, that crawl, walk, run kind of scenario. I think this year is probably going to be the tipping point for them to say, we're done with this because a 14-year-old child on the plan has severe spinal issues and the hospital, there's two hospital systems that we're going to when this child was born, they knew at some point it was going to have to have the surgery, but they had after a certain time of growth and whatnot. So 14 years old, it's time for him to have the surgery. Well, Shriners will do it. It's a nonprofit organization. They will do it for free. Well, the other part of it they can't do, so they have to farm it out to another one. And so in Texas, we have UTMB in Galveston. That's not part of the plan.
(40:59):
And I said, well, we're not going to have to have kid have half a surgery. And so I just said, I'm just going to call the hospital myself. Like whatever. Hey, so to David's point, there's somebody that's holding the purse strings over there, somebody's making these decisions, a human being, right? Hey, so we have this situation. This kid really needs to have this surgery at your facility because of the machines and the providers and everything. It gave them all the information. I may have shed a tear or two explaining that. And I said, what is it going to take? You're going to get paid in 30 days. What is it going to take? And they signed for 150% of Medicare. And I said, oh, by the way, we're going to go around the TPA because they're not going to like that.
(41:49):
And they were like, okay. I said, so we're going to have to do the claims a little bit different if you're okay with it. So then I called the stop loss. I'm like, so I have an idea. And they're like, oh, great. Here she goes again. And so I said, if we can get this accomplished, I know there's going to be some logistics going on behind the scenes, but I just, can we do this? Would you be okay with it to keep the integrity of the plan the way that we create it, right? Meaning that if they exceed the spec deductible, you stop-loss will pay. And they said, if you can accomplish this, yes, we'll do it. So I did it. And then of course. So it's just using those scenarios of this is real life stuff that happens, right? So we did it. The claims stop-Loss is paying for the fee for everything, all the paperwork, we're doing it. The kid had his surgery on June 12th of this year. He's walking, and it's miraculous. I was able to call the family and I cried because I'm also a parent. And so when you put yourself in those shoes, we're just humans. We just need access to care. And why is it so difficult? And so I think all those words to answer your simple question is just humanize it. That's it. Just humanize it. Sorry. Wow.
David Contorno (43:25):
Hold on one second. Yeah, mine's nowhere near as deep as that. But I do have a solution that allows you to weed through the gimmicks with a single question. It's four words. Before I ask you what that question is, you and or your broker, and you should be asking this, not only of your broker, but of every point solution they bring in. I can't tell you how many TPAs I've come up to me and said, David, we support everything you're doing. Direct contracting, reference-based pricing, independent unbundle plans. And after they go through their whole pitch, I ask them one question. Who in here can tell me what the tagline is to the Capital One commercial?
Eric Silverman (44:02):
What's in your role?
David Contorno (44:04):
What's in your wallet? And if you pull out a Blue Cross and Blue Shield ID card, get the hell out of my office and out of my client's office right now. Because if you're not doing it yourself, if your broker, your consultant, is not going into an environment where they're shopping for the highest quality, lowest cost for themselves, for their children, for their wives, for their husbands, if they're not doing it themselves, I promise you, they will not be doing it for you. What's in your wallet? Are you doing this for you and your loved ones every day? All the time? A hundred percent. That's going to weed through a lot of the gimmicks.
Eric Silverman (44:40):
Drop your lavalier. Thank you guys. That was amazing.
Shaping the Future: Key Trends and Predictions in the Benefits Landscape for 2025 and Beyond
October 7, 2024 3:55 PM
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