Top 7 Employee Engagement + RBP Questions & Answers

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Last month we hosted one of our favorite webinars yet, “Employee engagement + RBP: Employers’ secret to lowering healthcare costs.” The speakers shed light on how implementing a cost-containment solution like reference-based pricing (RBP) doesn’t mean an employer has to sacrifice the employee experience. During the webinar, our attendees came at us with some really great questions. Their questions were so good that we had to share with you, here on our mBLOG.

1) In my experience, employees don’t pay attention to education or information regarding healthcare until they actually need it. Any suggestions for combatting this?
It is true that employees often only show an interest in benefits that apply to their situations. One way to combat this is by approaching employee education with a marketer’s mindset, by focusing on awareness, interest, consideration and action.

First, identify the general actions you need employees to take. Then, develop a communication plan to relay the necessary information in an easily digestible manner. Finally, make it easy for employees to understand their options and use them in a way that makes sense for their situations.

2) If I will be undergoing surgery, whose responsibility is it to determine if the providers will accept a plan with RBP?
Unless there is actual acceptance of RBP in the form of a contract, there is no way to build absolute certainty about access to a specific provider for an upcoming surgery.  

However, some RBP partners will provide proactive patient advocacy to help schedule things like surgeries with receptive providers, either as a pre-arranged bundle or with up-front payment options. Also, some take it one step further by carving out networks for labs or imaging to help alleviate the access issue for scheduled, non-emergent care.

3) How does Maestro Health assist groups in implementing successful transition to RBP?
We begin by taking a look at the group, the demographics and the local healthcare markets to determine what is best for employees. From there, we start a discussion around cost-containment strategies for the plan. This may begin by transitioning from traditional self-funding to an independent third-party administrator (TPA) with a network to avoid access disruption and achieve a transparent environment to analyze claims and service patterns.

In addition, we arm employees with the education and resources they need to help them navigate the healthcare system using an RBP model. This ensures that they’re prepared to know what to do when they receive a balance bill, as well as understanding the advantages of visiting a provider that has a contract with the RBP plan.

It should be noted that our deep RBP knowledge is what allows us to implement solutions, create employee communication strategies and partner with the right vendors to create a transparent healthcare ecosystem that works for everyone involved.

4) Are there any shared characteristics of providers who are more willing to accept RBP plans?
Hospital systems in competitive markets may be more willing to tolerate predictable reference-pricing payments, especially if employers began to steer employees to that hospital system instead of the larger hospital systems in their area, creating a "safe harbor." Providers that are not connected to hospital systems may also be better candidates because they have more flexibility and are willing to make unique arrangements with employers.

5) Is there an element of quality that is considered when setting the payment level to the provider with an RBP solution?
Unlike many carrier networks, an RBP plan does not restrict the administrator's ability to direct care to high-quality, low-cost providers. While the benefit level may be a set multiple of Medicare, the flexibility in provider choice, possible incentive and transparent discussion about quality can result in employees seeking higher quality care for the same rates.

6) Do you foresee an RBP methodology being applied to pharmacy benefits?
RBP can be applied to Rx in limited situations outside of a pharmacy benefits manager (PBM). For instance, RBP can be applied in hospital services that focus on high cost drugs, or in instances where the plan design limits payment for a drug and facilitates better negotiation around that item.

7) What if providers don’t accept a plan with RBP and therefore employers would end up paying 100% of the billed charges?
In situations where healthcare providers refuse to accept RBP but access to that provider is a necessity, your RBP partner will typically assist the employee in negotiating payment. Payment is rarely 100% of billed charges. Further, in some markets, there are often alternative providers or means of access, like bundled services for some surgeries.

Of course, the best practice to ensuring providers are willing to accept a plan with RBP is by working with a partner that involves providers in their discussions when designing an RBP model.  We’ll be diving into how this works on May 14th during our webinar, “Build the dream: Constructing a cost-containment ecosystem for your organization.” Don’t miss it.

Keeping doctors out of the chair and part of the conversation

By Garrett Weldon, PT, DPT, Vice President of Provider Partnerships and Clinical Strategy, healtH2Business

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In 1891, an artist named Lukes Fildes completed a painting entitled, "The Doctor." It portrays a concerned physician watching over a gravely ill child. It is remarkably lifelike, perhaps because it is based on the artist’s own experience of losing a son before adolescence. Overlooking the sick child, the doctor is seated in a chair and appears deep in thought. Behind the little girl, with faces of fear and sadness, are the girl’s mother and father. Today, the painting begs the question: who is helping this little girl more? The doctor? The parents? Sure, both are present, but both are also an arm’s length away, immobile and frozen in their inability to intervene. There are no IV poles, cardiac monitors or tests to be run There is simply no active intervention being or to be done.

It wasn't until 1941 that penicillin was first prescribed and arguably changed the way we live and die. Now we have things like cortisone treatments, open heart surgeries, kidney transplants and rapid stroke interventions happening daily. If Sir Fildes were to paint this picture in 2019, I am confident the symbolic physician would no longer be simply sitting in a chair. He would be up on his feet, intervening.

However, having the doctor out of the chair comes with its own set of problems. Misdiagnosis, inappropriate interventions, over-treatment, under-treatment, human errors and debates about how, when, where and on whom to intervene. While these problems can be significant, I for one am still glad the doctor is out of the chair.  

It seems to be too often in the space of employee benefits that conversations turn to putting doctors back into their metaphoric chairs. From my perspective, many of the discussions happening are without consulting a large enough sample size of doctors or hospital systems to speak on their behalf. Often, anecdotal experiences are being used to frame the full provider experience. That is, simply, an error. Of course, doctors make mistakes, some of which even cause premature death, disability or financial hardship. But what if, instead of putting them back into the chair, we sought to give them a voice? What if we brought them to the table of creation? What if we gave them responsibility for a population? What if we worked with them to create and design plans in such a way the emphasis included responsibility and opportunity as opposed to just cost-containment. What if one of our top goals was to allow employers the flexibility they need to sit down with doctors and have meaningful conversations about their employee populations? What if our actions strongly suggested we view providers as a part of our community and in turn an integral part of the solution?

In the upcoming webinar, “Build the dream: Constructing a cost-containment ecosystem for your organization,” I’ll be exploring more of this topic. I will also be sharing my experience as a clinician and how the PPOs and ASO arrangements of today are not conducive to the vision of the healthcare delivery model I had and practiced, which ultimately led me to be a believer in reference-based pricing plans.

The top 7 self-funded data points you shouldn’t ignore

By Scott Bennett, Vice President of Access Innovation

Featured in BenefitsPRO’s Broker Innovation Lab

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For brokers, one of the most commonly identified perks for self-funded clients is better access to data for analytics. However, knowing where to begin when digging into the data can be an overwhelming task.

If you’re looking to paint a clearer picture for your clients around achieved and potential cost-savings, you should start by securing access to past hospital claims data (inpatient and outpatient) in a machine-readable format. This can typically be acquired from your client’s Third-Party Administrator (TPA) or Administrative Services Organization (ASO). From there, you can craft a data-driven strategy around medical costs and how they impact your clients’ bottom line.

Here are seven data points to look for within those claims and the assumptions you can make once you have access.

1. The hospital National Provider Identifier (NPI). The hospital NPI allows you to uniquely identify hospitals. There are also data tables with equivalent elements, also known as crosswalks, available to identify the hospital’s “provider number” or Medicare number related to public reports. 

2. The hospital name, address, city and state.* These fields provide good circumstantial evidence to help narrow down a provider. 

3. The hospital revenue code. This field identifies the department related to the billing on the claim line. 

4. An identifier as to whether the claim is inpatient or outpatient. This field is typically on the claim (in the form of a number) and helps if the analysis is filtered for just outpatient or inpatient. 

5. The hospital Current Procedural Terminology (CPT) Code (if outpatient) and the hospital related diagnosis-related group (DRG) (if inpatient). These fields help identify the procedure or services related to the billing on the claim line, and the modifier identifies how the services relate to other services in the same claim. 

6. The hospital billed charge. This field is typically on the claim (in the form of a number) and acts as a starting point when comparing external public hospital financial data or external public claim pricing data (like Medicare). 

7. The hospital allowed amount. If this is provided, it is an excellent way to look at what was actually paid. Using the billed charge and other data, you can compare the payment to external public hospital financial data or external public claim pricing data (like Medicare) to see how the payment/discount matches costs and/or Medicare benchmarks. 

*Note: This field is not always reliable and can vary greatly from claim to claim.

Once you have access to these data points, use a charting software to visualize the findings and identify outliers or trends across provider utilization, payment amounts compared to public market data or procedure trends that may lead to future issues for the plan. In doing so, you can begin to craft a data-driven benefits strategy for your clients that focuses on cost-containment and easily paint yourself as the expert they need on their side. Not sure where to start? Give us a shout.

To take a deeper dive into cost-containment strategies that may be a valuable solution for your clients, register for our upcoming webinar, “Build the dream: Constructing a cost-containment ecosystem for your organization.”

3 tips for driving employee engagement

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The way employers communicate benefits information has a tremendous impact on how well their benefits programs are understood, utilized and perceived by employees. Providing your employees with ample informative resources will help better convey your message. The better your benefits are communicated (and the better employees understand them) the more valuable they will become.

Many employers think that managers and supervisors are the best choice to share benefits information with employees. This makes sense, since direct managers are more approachable and accessible for questions. But as with all internal communications, there is a risk if done incorrectly. Take caution when communicating benefits information by taking the following best practices into consideration.

1 Avoid verbal communication hiccups.
Communicating inaccurate information to employees is always a major concern when using managers and supervisors to relay benefits information. Keep in mind that misinformation not only causes an employee relations problem, but also carries legal risks. Consider these tips to avoid problems:

  • Allow only Human Resources personnel to discuss benefits information with employees.

  • Remind supervisors and managers to review plan documents carefully in the case they do receive questions. Stress that they should refer employees to HR with any question they are unsure of how to address.

  • Communicate to managers and supervisors that they should never make any promises regarding any aspect of the benefits plan that the company is unable to keep, whether formal or informal.

2 Take caution with written communications.
All written materials (even informal documents) about benefits information prevails in court. As a precaution, make sure all written benefits communication is consistent with the official documents before distributing.

Employees often rely on summary plan descriptions to determine their rights under a specific plan. In the event of an issue due to discrepancies between plan documents and the summary plan document, the summary plan document can hold up in court. Because of this, it is crucial to make sure that the summary plan document is correct, current, clear and in agreement with the plan documents, handbooks and all other benefits information.

As a safety measure, be sure that these materials state clearly that the plan document has absolute authority over them. This information should appear in a separate paragraph in a prominent position. Consider using larger, italic or boldfaced type or a distinct border to make the information readily apparent.

Take further precautions by implementing the following processes:

  • Storing a copy of each communication or disclosure sent to employees, however informal.

  • Granting discretion to fiduciaries in the plan document.

  • Ensuring all documents relating to the plan do not include any misleading information before distribution. Requesting any additional information from the plan administrator regarding information that you believe may be misleading.

  • Reserving the right to amend the plan at any time, for any reason.

  • Developing a benefits guide that reflects your organization’s brand and includes all benefit information in one place.

  • State in the plan documents that plan amendments are to be made only in writing and approved by the business owner or plan administrator, if applicable.

3 Remember to keep your broker involved.
Your broker can help you customize your benefit plan communications and materials so you’re not relying on the generic information provided by the insurance companies. At the very least, they can add your logo to all communication pieces. Your broker can also help you create a communication plan to help you and your management team do the following:

  • Get the word out about how your benefits stand out in the job market by sharing your benchmark data.

  • Creating a multi-channel communication strategy to reach all generations of your employee base. For instance, younger employees might prefer on-demand resources (recorded videos or webinars, virtual avatars or decision-support tools, etc.), while other employees might prefer in-person meetings or one-on-one support.

To learn how to take employee engagement to the next step, join me next week for a webinar, “Employee Engagement + RBP: Employers’ secret to lowering healthcare costs,” on April 9th.  

mCHATS: Celebrating Maestronite Women

We were so pumped for International Women’s Day that we celebrated the entire month of March. We’re closing it out with our final mCHAT with Janice Bergeron, Corporate Controller. Be on the look out for future mCHATS, where Maestronties speak their minds and share their insights.


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Any advice you can give to a woman looking to advance in her career?

  • Set aside time periodically to reflect on what is important to you, both personally and professionally, and how your goals align with those priorities. Write them down and try to set a timeline for yourself. Break down your large goals into actionable steps.

  • Celebrate your victories and don’t dwell on the setbacks. Take away what you can from those experiences and move on.

  • Quit apologizing for taking up space in this world. Be confident in your value. If you don’t feel it right away, fake it until you do.

Are there any women you look to as inspiration? 
My sisters. I admire that they have identified what is important to them and pursued paths that fit their needs. They don’t believe they have to conform to someone else’s ideals.

Tell us about a mentor that inspired you in your career.
I’ve been strongly influenced by Bob Knott, President of SWC Technology Partners. He is incredibly sharp and challenges himself and others to strive for excellence. He demonstrates a lot of passion for his work and treats team members in a very respectful, genuine way. While working with him, I had the opportunity to grow tremendously and he gave me the autonomy and support to build a stronger accounting team. He helped me realize what kind of leader I wanted to be.  

Are there any books you've read lately that helped inspire you? 

  • Dare to Lead by Brene Brown

  • The Hate U Give by Angie Thomas

  • Eighty Days: Nelly Bly and Elizabeth Bisland’s History-Making Race Around the World by Matthew Goodman

  • The Immortal Life of Henrietta Lacks by Rebecca Skloot

mCHATS: Celebrating Maestronite Women

Yes, we’re still celebrating International Women’s Day. What can we say, one day just wasn’t enough and we’re having too much fun chatting with the women of Maestro Health. Our next mCHAT is with Rai Barney, Human Resources Manager.


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How did you get to where you're at now?
Faith, determination, drive and a whole lot of ambition! I’ve always sought out professional development and educational opportunities. I’m always in the classroom learning something new.

Care to share any fun facts about yourself?
I won a 2012 Volkswagen Beetle on Oprah’s “Favorite Things” episode in 2010! I’m affectionally known as “Twirl Girl” in the Harpo Media community.  

What is the best career advice you've ever been given?
Stand up for yourself and help someone along the way. Be an advocate for change!

Can you tell us about a mentor that inspired you in your career?
My mentor is Dorri McWhorter, CEO of YWCA. The YWCA of Metropolitan Chicago is the oldest and largest women’s organization in the region, with a mission to eliminate racism and empower women. I love Dorri’s drive and determination to impact social change in the world. She is very relatable and filled with positive energy! We are both members of Oprah’s TV church, “Super Soul Sunday!”

Are there any books you’ve read lately that inspire you?
I love the Crucial Conversations book. I am also a licensed Crucial Conversations instructor and believe in the communication tools they offer for high performers when the stakes are high.

How do you get involved around your community?
I serve on the Board of Directors for the Arts & Business Council of Chicago. Our vision is to create a vibrant arts community in Chicago. I also volunteer with various non-profits within the Chicago area, providing complimentary career coaching to underserved communities.

Any advice you can give to a woman looking to advance in her career?Network, network, network! Be open to change and remain optimistic – attitude is everything!

What do you like about Maestro Health?
I love that we live our values! I see our “kindness” value in action on a daily basis in our office. My other favorite value is “humility.” When we humble ourselves, we are able to positively create the change this is needed in the world.

mCHATS: Celebrating Maestronite Women

Even though International Women’s Day was earlier this month, we’re continuing the celebration by bringing you another mCHAT. Next up is Nancy Reardon, Chief Strategy & Product Officer, who’s discussing all things career, role models and overcoming obstacles.


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Any advice you can give to a woman looking to advance in her career?

  • Bloom where you are planted.

  • Be so good that no one can ignore you and the opportunities will follow.

  • If given a “seed,” grow a garden. Be an attentive listener and add value between the lines. This means being very proactive and finding your own opportunities to shine – don’t wait for your path to be paved.

  • Don’t ever be afraid to ask questions – silence assumes you know.

  • Be comfortable with who you are.

What advice do you have for men in the workplace who want to express their advocacy for women empowerment in the workplace and aren’t sure how to start?
Stealing from Nike – “Just do it.” It’s not about male or female in my opinion, it’s about leadership, teamwork and camaraderie. Male leaders should take the same approach with women as they would for a male counterpart; some of my best colleagues and advocates have been men. 

What do you like about Maestro Health? 
It begins and ends with our people – Maestronites. We hire people who possess and live by our core values: teamwork, humility, urgency, bold thought, honesty, preparedness, biz-love, fun, kindness. These are attributes you simply cannot teach.

The end result is  an expressive workforce made up of diverse opinions and backgrounds. This is what makes us stronger as a company. I feel truly privileged to work at a company that values what makes us unique – as opposed to calling out why we are different. 

mCHATS: Celebrating Maestronite Women

By Bridget Houser, Accounting Supervisor

We’re celebrating International Women’s Day all month long at Maestro Health, because one day just wasn’t enough. One of the ways we’ve been celebrating gender diversity in our workforce is through our “mCHATs” with some of the women at Maestro Health, where we discuss everything from careers, role models and overcoming obstacles. Next up is Bridget Houser, Accounting Supervisor.


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How did you get to where you're at now? 
I studied Accounting and International Business at Indiana University. After graduation, I sat for the CPA exams and became a CPA. I started my career in public accounting at Ernst & Young and then spent two years working at Frontenac, a Private Equity firm in Chicago. I’ve now been with Maestro Health, where I’m an Accounting Supervisor, for three years.

Care to share some fun facts about yourself? 
I worked at Cold Stone Creamery for 5 years and loved every minute of it!

 What is the best career advice you've ever been given?
The best career advice that I’ve been given is that at the end of the day, work is about the relationships that you’re creating. It’s important to be learning and to be an efficient, productive employee, however, it’s also important to be building and nurturing relationships along the way.  

Are there any books you've read lately that have inspired you? 
I recently read Tribe of Mentors by Tim Ferriss. It’s a compilation of advice from various business leaders, celebrities, health gurus, etc. The people featured in the book share their personal success and failure stories and how they got to where they are today. My main take-away from the book is that everyone has their own path to success and ‘success’ looks different to different people. The things that work for some might not work for others and that’s okay. Reading about ‘successful’ people’s pathway to success and the failures/challenges that they’ve overcome was very inspirational.

 How do you get involved around your community? 
Outside of Maestro Health, I am a part of the Core Power Yoga community. I recently became certified as a yoga instructor through Core Power Yoga. Being a part of this community has given me a healthy hobby and a place to be surrounded by like-minded people who inspire me to be a better person. It has also helped to give me a work-life balance and a place to recharge outside of work. I am excited to give back to this community by teaching classes and helping other students gain what I’ve gained through yoga.

I also volunteer at Park Community Church in the kids care room so that parents can drop their kids while they attend service. I enjoy spending time with the kids and am happy to give hard-working parents an hour break in their week!

What do you like about Maestro Health? 
I like that I’m surrounded by smart, hard-working people who also value a good work culture. I find that people at Maestro Health truly embody our core values: biz-love, fun, preparedness, teamwork, kindness, humility, urgency, bold thought and honesty.

Any advice you can give to a woman looking to advance in her career?
It’s important to set goals and to write them down. Though your career likely won’t progress in a straight line, it’s important to lay out a roadmap of where you think you want to go. Equally important is setting aside time to reevaluate these goals as they will likely evolve over time. Having a mentor, ideally outside of your place of work, is also important as you’ll receive professional/personal advice from someone who’s already been where you are.  

mCHATS: Celebrating Gender Diversity

By Kirsten Williams, Product Manager, Benefits Administration

Last week, the world celebrated International Women’s Day. At Maestro Health, we simply didn’t think one day was enough. So, we decided to take the entire month of March to celebrate the gender diversity in our workforce by chatting, or “mCHATTING,” with our employees about careers, inspiration and overcoming.

We’ll be sharing our mCHATs throughout the month of March, here on our mBLOG. Next up is Kirsten Williams, Product Manager – Benefits Administration.


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How did you get to where you're at now?
Prior to joining Maestro Health, I was in HR, having started my career as entry level working up to eventually running an HR department for a large insurance brokerage firm. It was a very traditional firm.

When our son was born four years ago and subsequently diagnosed with cerebral palsy, the firm did not meet my current family needs with respect to flexibility of hours in the office. He had a myriad of medical appointments and therapy sessions during the weekday. It didn’t matter that I worked hours at night to complete my work because I wasn’t physically at my desk from 8 am – 5 pm. My boss and the CEO, who was male, was very approving of the flexibility, but the traditional culture hadn’t caught up with his thinking.

When I was looking for something new, I called my old buddy Shay Butler for a reference at Maestro Health, and the rest is history! I am pleased to look back at my former company and see how far they have come with advancing women into leadership roles and being more flexible with hours physically at the office. I would like to think that my experience helped catapult the company in the right direction.

What are some of the personal experiences that have influenced your thinking around gender diversity in the workplace that have motivated you to get involved in being an advocate for change?
My first real job out of college was at a window manufacturer where all the executives and most of the line managers were men. I remember a woman being hired over a few of the plant managers for a hefty salary compared to what the men were making. I’m embarrassed to admit that even I was shocked by it! An experience like that illustrates how difficult it is to change the mindset around a woman’s qualifications. Many of us have been conditioned to think that men are superior due to our own upbringing and experiences, especially if we had mothers that didn’t work outside the home. 

What do you like about Maestro Health?
Most employers say family is first but I really feel it at Maestro Health. I have never felt guilty when a family emergency came up and I had to put my work second. As a working mother, this is incredibly important to me. The key to making this work company-wide is a mutual respect to do a good job by both the employer and employee. For example, last week my son had a dental emergency and I had to attend to him. Knowing that it would take a few hours of my day I told my husband that I would need to work at night so I could catch up on things I missed. I respect Maestro Health’s time – just as they respect mine.

Do you feel that Maestro Health is a diverse workforce?
I’m proud to work at Maestro Health for a number of reasons. And I do think that we have a good mix of men and women throughout all parts of the company. It would be nice to see more diversity in roles traditionally held by women vs. those traditionally held by men. But as with anything, we are not perfect, and can always strive to do better.

How do you get involved around your community?
I grew up in a very small community where I learned the importance of helping others that are less fortunate. I’ve been active on various boards, and I am currently the President of Riverview Center Board of Directors. My husband Chris and I have raised money for the March of Dimes and our local hospital. Recently, we have gotten involved in Ainsley’s Angels and the Miracle League of Dubuque

In addition to our four year old, we have a fifteen year old son who is very active in sports and a seventeen year old niece who has lived with us for the past year. Welcoming her into our immediate family and being involved in my community has allowed me to tap into a skill set I didn’t know I had. There are so many benefits of volunteerism (or surrogate parenting!) that bleed into how one performs as an employee.

What is the biggest roadblock you've experienced in your career and how did you overcome it?
I think the diagnosis of Peter’s cerebral palsy caused a roadblock in my career because I was in the wrong company for the circumstances. I didn’t feel like I could progress in my role while still staying actively involved in his treatment. I overcame it by finding another position at Maestro Health that allowed me to thrive while caring for those who are most important to me. I was very lucky to have that opportunity; but it also speaks how you carry yourself can have consequences down the road. Had I been a poor performer when the circumstances weren’t right, or blamed others for my situation, I wouldn’t have other opportunities. I took control of the situation and made the move for the right reasons.  

mCHATS: Celebrating Gender Diversity

By Sheryl Simmons, Chief Human Resources & Compliance Officer

While it may seem like International Women’s Day was first put on the map only a few years ago, the holiday dates all the way back to 1909. Today, International Women’s Day is recognized and celebrated in more than twenty-five countries.

We at Maestro Health want to join in the fun but decided one day just wasn’t going to cut it. So, to celebrate International Women’s Day, we’re taking the entire month of March and “mCHATTING” with some of the women at Maestro Health about careers, inspiration and overcoming obstacles.

We’ll be sharing our mCHATs here on our mBLOG. First up is Sheryl Simmons, Chief Human Resources & Compliance Officer.


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Care to share some fun facts about yourself?
I love to sail our boat the Barcelona. I am a total travel junkie. My blood type is French roast. My playlists include 80s hair bands and old school jazz. I don’t have an athletic bone in my uncoordinated body.

How did you get to where you are now?  
I believe it has been a combination of being open to possibilities, pushing myself, and simply being in the right place at the right time. In terms of my journey to CHRO at Maestro Health, I was the Vice President of Human Resources at Group Associates, which Maestro Health acquired in 2015. Prior to that, I was the Director of Human Resources at Five Brothers Asset Management Solutions.

What advice do you have for other women in healthcare?  
Some of the best advice I have been given in my career is to listen. That’s important enough to bear repeating. Listen. Believe in yourself, surround yourself with strong people that push you to grow, and remember to send the elevator back down. It’s essential that you know your business inside out. As you grow in your role and career, be able to talk the talk of your C-suite and other peers. Keep yourself open to possibilities. You never know when an interesting opportunity will knock on your door.

What are some of the personal experiences that have influenced your thinking around gender diversity in the workplace that have motivated you to get involved in being an advocate for change? 
Not just gender diversity but diversity. Period. The idea of denying a highly qualified candidate the opportunity to grow in their career or enrich your business because of their physical makeup is outrageous. Gender, sexual orientation, weight, age, ethnicity, religious beliefs – are you kidding me? The war for talent is raging. Intentionally narrowing the talent pool based on irrelevant details is more than just illegal. It’s a narrow mindset that only does your organization a disservice.

What do you like about Maestro Health? 
So many things but first and foremost that we encourage our employees to bring their authentic self to the job every day. Of course, we expect professionalism and for people to embrace our culture and core values. But the fact that we meet them where they’re at and celebrate the diversity they bring to our family – that’s true biz-love.

Are there any books you've read lately that helped inspire you?  

  • Doing Good Better: How Effective Altruism Can Help You Help Others, Do Work that Matters and Make Smarter Choices About Giving Back by William MacAskill

  • The Empathy Effect: Seven Neuroscience-Based Keys for Transforming the Way We Live, Love, Work and Connect Across Differences by Helen Riess, MD

How do you get involved around your community? 
Volunteer, volunteer, volunteer. I believe human beings are fundamentally wired to give. I love that we embrace this at Maestro Health. Maestronites have participated in a number of volunteer and fundraising opportunities, such as working at food pantries, making blankets for the homeless and foster kids, and school supply drives across all four of our locations. You don’t have to be rich to be a philanthropist. Your time is incredibly valuable. Get involved in what matters to you.

Are there any women you look to as inspiration? 
I really enjoy following Libby Sartain to hear her perspective on Human Resources. 

What is the biggest roadblock you've experienced in your career & how did you overcome it? 
It’s sadly not an uncommon experience, but I have worked at organizations where men in positions of authority viewed women as “lesser” in the business world. How did I overcome it? I put them in my rearview mirror. Life is too short for that nonsense.

Research suggests that women can face different challenges in the workplace making it more difficult to access opportunities, networks, resources, etc. In your view, what are some of these systemic challenges that still need to be addressed? 
Unfortunately, there are still many cultural gender biases that still exist both in the workplace and in relationships. For instance, childcare and managing a household are still often considered a woman’s responsibility when it's truly a parental or partner responsibility. 

A common gender bias issue that takes place in the workplace deals with the mental framework of emotional and verbal responses, i.e. a man will make a statement and he's considered assertive but if a woman makes the exact same statement she’s considered “bitchy” and consequently overlooked for growth opportunities. 

It’s also all too common to see women who struggle with imposter syndrome. We see it a lot in high-achieving women who believe they're unworthy of the roles they have earned, and fear others will expose them as a fraud. So not only are they facing external challenges, they’re having to refute their internal dialogue as well.

While there’s no magic wand to solve for these challenges, I believe open discussions embracing gender diversity, such as this blog series, can be a piece of the puzzle to help us get there. 

Overall, it should never be about men vs. women. Instead, it should always be about who is the best person for the job. And when the best is a woman – fight for her – not because she's a female but because she's the best. 

New year, new data: 2019 Employee healthcare views

It’s January – a time for an honest look at what needs to be addressed in the year ahead of us. With healthcare always being in the forefront of our minds, Maestro Health surveyed 1,000 employed consumers to gauge their current views of healthcare and one thing was very clear – they want their employer to step up and truly address the cost struggle and increase employees’ health outcomes.

 Here is a look at the full survey findings:

  • 68% of respondents say the cost of healthcare has gone up in the past three years

  • 62% of respondents feel their employer does not serve as a resource for their healthcare-related questions

  • 33% of respondents don’t understand their medical bills

  • Only 33% of respondents say they completely understand the health coverage offered through their employer

  • 44% of respondents say their employer doesn’t offer anything outside of health benefits for employees to meet their health goals

  • 60% of respondents say that financial incentives would make them more willing to improve their health regime

  • 39% of respondents have chosen not to go to the doctor to avoid costs

  • 54% of respondents don’t know what the term “self-funded healthcare” means 

The results are clear: there is still much work to be done to improve employers’ involvement in educating, empowering and motivating their employee base when it comes to their health. Having the right tools to provide cost containment solutions and consistent education and engagement are part of closing that gap.

These insights have even more fuel to our mission to make employee benefits people-friendly again by lowering costs, improving health outcomes and transforming the healthcare experience. At Maestro Health, our solutions are optimized to enable and inspire employers to play the critical role of keeping their employees happy and healthy. This type of support is clearly what employees are seeking. 

You can find more tools and resources on how to lower healthcare costs for your employees and improve outcomes at GameChangerHR.com.

2018. What a Year.

It’s that time of year again. Festivus parties have ended. Holiday cards have been sent. A new year has begun. And we’re taking a step back to look at everything 2018 brought for Maestronites.

We started the year off with a bang with our acquisition by AXA. Joining forces with a worldwide insurance leader added even more fuel to our mission to make employee health and benefits people-friendly again.

Shortly after the acquisition, we launched our health plan management approach to self-funded benefits. By incorporating a people-friendly reference-based pricing model, we were able to partner with 170 new employer clients, like Leith Automotive, Secure Health and Phoebe Putney who were looking to change the healthcare game by lowering costs and improving health outcomes for their employees. 

Passionate about the value HR leaders offer to organizations, we equipped them with resources to help them not only land a seat in the C-Suite, but better position them to successfully collaborate with their C-Suite team. After all, HR is uniquely positioned to help drive down one of their organization’s largest expenses – healthcare.

In 2018, we continued to expand our partnership with Aflac® to offer their brokers and employers a robust benefits administration solution called voluntaryEDGE™. This partnership with Aflac has made it possible to simplify and streamline the complete benefits experience for employers looking to provide comprehensive voluntary benefits packages, including accident, hospital, critical illness, vision, dental, disability and cancer insurance, to employees.

We on-boarded 65 new Maestronites, including more customer advocates, a new Chief Financial Officer and data analysts, to help us meet our employers’ needs. (Spoiler Alert: We’re still hiring.) To house these new hires, we moved our Detroit Maestronites to a bigger and better office and we began breaking down walls to expand our corporate headquarters in Chicago.

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Why Employers Should Care About Their People’s Financial Stress

Let’s cut to the chase. Financial stress hurts your employees and that hurts your business. Dig into related loss of productivity, presenteeism, higher medical insurance claims, and suddenly the impact on your company’s bottom line gets very real.

So, what’s an employer to do? Is employee financial stress even your problem? Is your company’s profitability your problem? You’re tracking with me, aren’t you?

Financial stress isn’t a new concept. Employees around the globe have been struggling with this for years. In 2017, one study found that only 35 percent of employees in the U.S. expressed feeling satisfied with their current financial situation, which was a drop from 48 percent in 2014. That’s a double-digit drop in just 3 years. It’s not just young employees either. The number of bankruptcies filed by baby boomers has tripled since 1991. Strategic organizations are waking up to the need for financial wellness tools to maintain and improve employee health and work productivity.

Financial stress can have a serious impact on your employees’ health.

When money is keeping your employees up at night, it can take a major toll on their health. Financial stress has been linked to the following physical health conditions:

  • Migraines

  • Cardiovascular diseases

  • Insomnia

Another scary fact – a 2018 survey found that 8,000 Americans who suffered a “negative wealth shock,” defined as losing at least 75 percent of their wealth in two years, have a 50 percent increased risk of dying in the following two decades. The Great Recession not only resulted in employees losing their financial footing, it took a heavy toll on their physical and mental health.   

The more employees suffer from financial stress, so will work productivity.
When you’re experiencing money troubles, it’s difficult to think about much else. How many times have seen employees stepping into the hallway to take a call? How many have needed to leave work during their shift to pay basic utilities to keep their power on that day? A recent PwC study found that 43 percent of employees feel distracted by their finances to the point where they spend three hours or more at work thinking about or dealing with those issues. Along with distraction, financial stress leads to a rise in absenteeism. In fact, employees with the highest levels of debt are twice as likely to miss work

Fortunately, there are ways employers can address financial stress.
The first step is identifying how prevalent the problem is at your organization. Start looking for clues. Get your hands on your HR data. Are you getting feedback from your managers that they’re fielding an uptick in debt collector calls? Are you seeing a spike in wage garnishments? Has there been an increase in 401(k) loans and withdrawals?

If you’re seeing the symptoms, use your HR data to help employees find a cure. Begin taking a holistic approach to health and wellness by treating the whole employee. More employers are taking a complete look at their employees’ wellness in regard to their financial, mental and emotional health, rather than just focusing on their physical health. There are several reputable vendors in the financial wellness space. Look for a partner that is able to offer intuitive financial education for your employees. Consider adding a low cost loan option to your employee benefit program utilizing a socially responsible source such as Kashable to cover unexpected expenses.

Take a hard look at the healthcare benefits your organization offers. Do they ensure your organization is providing employees with access to quality care at low healthcare costs. The PwC study found that 22 percent of employees stated “lower healthcare costs” would help them achieve their future financial goals. It is imperative that we take the initiative to educate our employees how to gain maximum benefit from their healthcare benefits. Recently I had a conversation with an individual struggling under the high-deductible plan her employer had put in place to lower premiums. She had no idea that participating in the plan qualified her for an HSA. She was missing out on the triple tax benefit of an HSA while struggling with how to best utilize her new plan and not add to her financial burden.   

I know, lowering healthcare costs for employees sounds like an impossible task if you’ve been dealing with premium hikes, year after year. We’re seeing many mid-size employers opting for a modern health plan management approach to self-funded benefits to drive down cost while maintaining quality benefits. This includes things such as partnering with a people-friendly reference-based pricing vendor that reaches out directly to providers and negotiate fair-market reimbursement using Medicare as a reference-point. They prevent employers from paying inflated claims that are commonplace with traditional carrier plans. The people-friendly part is key. They differentiate themselves by providing employees with education and the support they need to help them deal with things like balance billing issues.

If you think you’re stressed out trying to lower your company’s benefit costs, imagine the stress your employees are feeling trying to live those benefits. As HR business leaders, we need to find the right balance for both the company and the employees. When more than one in five employees express a willingness to forgo future pay increases for better healthcare benefits, they’re sending us a message. We need to listen.

As innovative companies embrace the holistic approach to health and wellness, they’ll begin to provide benefits that address their employees’ financial wellness needs. In HR we want the win-win solutions. There are so many options to provide our employees significant relief in the financial wellness space. Why would we put it off any longer?

You can find more tips and resources on how to lower healthcare costs for your employees and your organization at GameChangerHR.com.

Breaking Down Barriers to Improve Health Outcomes

It’s no secret that U.S. healthcare spending is through the roof. We continue to hear alarming stats on how the U.S. currently spends twice as much on healthcare than ten other high-income countries. We continue to analyze why we’re not seeing better outcomes with all of the money being poured into the healthcare system. People blame these higher costs and undesirable outcomes to poor American diets, inefficient healthcare delivery systems, overpriced pharmaceuticals and unit costs. However, little attention seems to be given to things outside of the stereotypical healthcare experience, like limited access to healthy food options, lack of education, financial hardships or unsafe neighborhoods. These environmental, social and economic factors, also known as social determinants of health, can greatly impact an individual’s health, yet historically our healthcare system has not specifically focused on them.

Understanding the social determinants of health and why they matter.
Everyone deserves an opportunity to make choices that lead to good health. But in order for this to truly become a reality, advances are needed not only in healthcare delivery and technology but also in education, childcare, housing, community planning, business, transportation – just to name a few.

 According to Healthy People 2020, there are five key areas of social determinants of health:

  • Neighborhood & built environment – access to safe housing, parks and playgrounds

  • Health & healthcare – access to health coverage and quality care

  • Social & community context – support systems, discrimination and stress

  • Education – literacy, language, access to quality education and vocational training

  • Economic stability – employment, medical bills and income

These areas have the potential to greatly affect an individual’s health. In fact, social and environmental factors impact the risk of premature death by 20 percent, while genetics has a 30 percent impact. Health disparities also pose great financial risk and account for a whopping $102 billion in direct medical costs in the U.S. each year.

How to break down barriers to promote good health for all.
It’s clear that a traditional population health management (PHM) program simply won’t cut it anymore. Every person is unique and so is their health journey. An effective PHM strategy should be designed to be flexible enough to adjust care for someone who has limited access to public transportation, is unsure of their ability to afford healthy food options or is dealing with economic and family hardships. At Maestro Health™, we believe the entire PHM strategy must be redefined. That’s why our HEALTHY(me)™ program takes a holistic approach to address a person’s physical, financial and emotional wellbeing.

This holistic approach allows us to meet the person where they are on their healthcare journey and understand what “healthy” looks like to them. For some it may be hitting 10,000 steps on their Fitbit, while others would like to see a decrease in their A1C levels.

However, it must go beyond identifying personal health goals. We believe an effective PHM strategy must dig deeper to understand the barriers they are facing in their everyday lives that are preventing them from finding their healthy. For instance, if lack of public transportation has historically been a problem, then a personalized care plan should include something as simple as arranging a ride to a doctor’s visit.  

Take it one step further and apply technology to expand your data set. Utilize this robust data to derive additional insights to further identify and address an individual’s specific needs. According to PwC, 78 percent of providers stated that they are unable to identify their patients’ social needs due to a lack of data insight. Our HEALTHY(me) program provides nurse care coordinators access to a person’s personal and healthcare profile, in an effort to close gaps in care and assist providers in addressing their patient’s specific needs.

A PHM strategy that does not consider the social determinants of health, does not consider a person’s overall wellbeing. You can learn how we’re integrating this approach with our self-funded solution to help simplify experiences, improve health outcomes and reduce healthcare costs at GameChangerHR.com.  

3 Reasons I’m Excited to Be Here

By Florian Bezault, Chief Financial Officer

It’s official. I am a Maestronite. While I have spent most of my career with AXA working on everything from corporate finance to investor relations & risk management to healthcare operations, I’m beyond thrilled to begin this next chapter of my career as Chief Financial Officer at Maestro Health. Here’s why:

1. I share a passion to transform U.S. healthcare with my fellow Maestronites.
It’s no secret that the U.S. healthcare industry has reached its tipping point. The U.S. spends over $3 trillion on healthcare each year, yet Americans aren’t getting any healthier and the majority find it nearly impossible to navigate the complex healthcare landscape. That’s why I’m so proud to be working for a company with a mission to disrupt the industry by making employee health and benefits people-friendly again and to take consumer engagement to the next level.

2. It’s clear why CFOs love our approach to employee health and benefits.
I’ve been diving in and learning more about the solutions Maestro Health offers employers. The more I learned about our health plan management approach to self-funded benefits, the more I was convinced this is a no-brainer solution for any CFO in the U.S. While healthcare costs are at an all-time high (so much so that companies like Starbucks are paying more on healthcare than coffee beans) the (me)SELF-FUNDED BENEFITS™ solution has been saving our clients an average of 20 – 30 percent off their healthcare costs in the first year. For some companies, this could be millions of dollars in savings.

3. The culture at Maestro Health is one that cannot be beat.
At many companies, office culture is something that people like to talk about, but few truly walk the walk. I have quickly discovered that isn’t the case at Maestro Health. The values aren’t just painted on the walls at each office. The people in each office truly embody the values themselves. In the short time I’ve been working at Maestro Health, I’ve met people from all walks of life, that display the same level of teamwork, humility and bold thought while collaborating and working together.  

I am eagerly taking this next step in my career with Maestro Health. I’m excited to be a part of transforming the U.S. healthcare industry at such a critical time by solving the challenges experienced by far too many across the country.

4 Points to hit when talking benefits with your CFO

By Sheryl Simmons, Chief Human Resources Officer

As an HR leader, it’s essential to collaborate with all members of your C-Suite. Doing so is not only important to your organization’s success, but it also helps you share your unique insight and be seen as a key member of the C-Suite table. What better opportunity to display your value than by tackling the healthcare dilemma? After all, it’s imperative that your business crafts a strategy to tackle the skyrocketing costs and poor employee experiences with healthcare. Your CFO is already keenly aware of this. Partnering with them to strategize your organization’s approach can likely be a win-win for all, but it’s essential that you begin by learning to speak your CFO’s language for a successful partnership.

1 Treat benefits like an investment opportunity.
When speaking with your CFO, focus on demonstrating the investment opportunity a modern benefits approach can offer your organization. Let them know that your company is in the healthcare business. In fact, every U.S. company is in the healthcare business. Healthcare is the second or third largest expense for most employers. General Motors spends more on healthcare than steel. Starbucks spends more on healthcare than coffee beans. Once your CFO is on-board for a partnership, lay out the strategic, business-focused reasons for implementing a modern benefits approach.

2 Give them the 411 on cost-saving solutions.
Provide a high-level view of the variety of new, cost-saving healthcare solutions available in the market. Be prepared to answer why you selected the options for your company, as well as why you don’t see the others as a good fit.

Keep in mind, your CFO is not entirely fluent in HR speak and that’s okay. Share your knowledge. Get comfortable speaking from a financial viewpoint about the modern solutions organizations are using to combat rising costs like:

  • People-friendly reference-based pricing models that increase access to quality care AND lower healthcare costs
  • Pharmacy benefit management vendors that provide transparent contracting
  • Medical management that is integrating throughout the employee experience

3 Find the numbers. Know the data.
If you have access, dig into your claims data to show the breakdown of your current healthcare costs. It is highly probable that a small population of your employees are driving the majority of your healthcare costs. These are the numbers you need to bring to your CFO. If you don’t have this data available to you, hit your CFO with the fact that just 5 percent of Americans are driving over half of the cost of U.S. healthcare.

Use this information to forecast how new approaches to benefits can lower your healthcare costs. For example, implementing a self-funded solution that offers holistic care management can help improve the health conditions of employees who need it the most, while also offering wellness initiatives to maintain the health of your healthier employees.

4 Show them the money.
It’s fair to say that your company’s bottom line is top of mind for your CFO. In fact, 65 percent of CFOs claim “cost management” as their top priority. With that being said, you must be able to show them true numbers on how a new self-funded solution can provide real cost-savings for your company’s bottom line.

This can be done by showing a comparison of the cost trend of traditional benefit strategies. Fully-insured employers can expect to continue to see a 20 percent increase in their benefits, while self-insured employers that offer traditional PPO networks, can expect a 5.5 percent cost increase for the future. However, employers that are implementing creative healthcare solutions like a health plan management approach to self-funded benefits are experiencing an average decrease in healthcare costs of 20 percent in their first year.

If you’re already in the process of researching vendors that offer these modern approaches, be sure that you’re also making it a requirement for them to provide you with an ROI analysis. If they can’t provide this for you, do you truly trust them to partner with you?

You can find more tips and resources to help you grab a chair and collaborate with the entire C-Suite at YourHRSeat.com.

Traditional vs. People-friendly reference-based pricing

By Ray West, Chief Growth Officer

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If you’re familiar with reference-based pricing (RBP), then you’re also likely aware that many early adopters did not have the best experience. They were promised RBP was a surefire strategy to prevent overpaying for medical claims. However, employers experienced an alarming amount of noise from their employees, who were struggling to cope with balance billing and fear of medical debt. Since then, some vendors have evolved the RBP game to include a people-friendly approach.

The traditional reference-based pricing model.
When RBP emerged approximately ten years ago, the model leveraged median prices in geographical locations as a reference-point for how much an employer would pay for provider services. RBP vendors then began holding strict reference points to Medicare for all service types. This created a “take it or leave it” message for providers, leaving them understandably frustrated.

This traditional model also left employees in the dark. As if the healthcare experience isn’t complex enough, employees were receiving bills from their providers for the balance their health plan was refusing to pay (aka, a balance bill). These bills came as a surprise to employees and vendors were providing little to no education or support to help guide employees on how to resolve these balance bills.

Eventually RBP vendors began to grow more flexible with their payment models by incorporating additional data to determine what was an appropriate amount to pay. Up-front and real-time member education became a part of their offering. Some even began offering employee assistance with balance bills.

The people-friendly reference-based pricing model.
Today, employers are able to implement a modern reference-based pricing model that eliminates over-paying for claims, but also offers complete transparency and the support employees need – the people-friendly reference-based pricing model. This new model improves the experience for everyone involved:

  • Providers receive fair-market reimbursement
  • Employers get connected with providers and see significant healthcare savings and transparent claims data
  • Employees get the support they need to navigate the complex healthcare system

People-friendly reference-based pricing still has Medicare at its core. However, it’s no longer a rigid, one-size-fits-all approach. Instead, these vendors directly reach out to providers and negotiate a fair-market reimbursement using Medicare as a reference-point. This ensures providers are being paid fairly for services and reduces the risk of employees receiving a balance bill.

It’s important to note that people-friendly reference-based pricing is not solely based around Medicare. These vendors offer employers a proactive provider disruption analysis, which helps identify the doctors an organization’s employees are used to seeing. This will often lead to provider outreach and contracting with providers to guarantee the provider will accept the negotiated pricing, essentially replacing traditional PPO networks with RBP networks.

The education and support offered by people-friendly reference-based pricing sets it far apart from the traditional reference-based pricing model. Vendors will navigate employees to high quality and low-cost providers in their area. One way they do this is by implementing copay incentives – offering lower copays for medical services if they visit pre-negotiated providers. In addition, employees are given education on how to react if they receive a balance bill. They’re also given the support and guidance necessary for handling a balance bill to eliminate the worry of medical debt.

Here’s a look at what the people-friendly RBP process can look like for an employee:

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If you’re working with an RBP vendor or thinking of implementing one, don’t settle for just any vendor. To determine if they’re truly people-friendly, ask them these simple questions:

  • How do they handle balance billing?
  • Will they be a co-fiduciary for the plan and provide legal services if needed during balance billing?
  • How do they support employees in learning how to navigate the healthcare system?
  • Are they flexible to your needs?

Learn more about how employers are changing the healthcare game by implementing innovative solutions to drive down their healthcare costs by visiting GameChangerHR.com.

Why companies need HR in a seat at the table

By Sheryl Simmons, Chief Human Resources Officer

As HR professionals, we’re well aware of the many unfortunate stereotypes of HR. We’re the office referee, the fashion police, the corporate party planner and the bearer of pink slips. The truth is, HR is far more valuable. As HR leaders, we are strategic advisors and revenue-drivers. We’re efficiency experts. We’re cost-savings strategists. So, it should come as no surprise when HR leaders pull their seat up to the decision-making table.

HR leaders have unique insight into their companies.
Employees are a company’s most valuable asset, and no one has as much visibility into what makes them tick like HR. We have our fingers on the pulse when it comes to employee retention, talent recruitment, productivity and even the general health of employee populations.

We’re able to identify the challenges our companies are facing. In fact, 47 percent of HR leaders claim employee retention and turnover as their top workforce management hurdle, with recruitment and corporate culture management following closely behind. Meanwhile 46 percent of HR leaders state employee burnout is responsible for up to half of their annual workforce turnover. And, 30 percent of HR leaders see the need to decrease healthcare costs for their organization.

Innovative brands are leveraging the value HR brings to boost their bottom lines.
In fact, large brands like General Motors, Dunkin’ Donuts and Xerox have seen the value of HR so much so that their CEOs all have an HR background. One of the motivating factors for this – revenue.

  • Customer loyalty improves by as much as 200 percent when employees are engaged.
  • A 10-percent investment increase in HR can boost an organization’s profits by nearly $2,000 per employee.
  • Companies that excel in talent management increase earnings by spending 27 percent less than their competitors.

Money talks and these brands are seeing the fiscal advantage of adding HR leaders to the C-Suite table.

It’s time to grab a chair and join the boardroom decision makers.
We’ve covered why it’s essential for HR to have a seat at the C-Suite table. I’ll be sharing how HR leaders can get there at the SHRM Annual Conference & Exposition on Tuesday, June 19th.

Visit YourHRSeat.com for more details.

Lifting the veil on the healthcare experience

By Rob Butler, Chief Executive Officer

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It is official. The healthcare industry has reached its tipping point. There are many differing opinions per when it actually happened, but I’m not sure if it matters. What does matter is: what happens now. 

What will happen first is what you have already seen. Industry employer giants like Amazon, Apple and Comcast will repeatedly show up in the headlines as employers seek to take matters into their own hands – driven by the underlying unsustainable economics of healthcare costs that are bludgeoning their balance sheets.

The truth is, employers don’t need to wait for the "Amazons" to create new healthcare companies in order to lower their healthcare costs and help their employees get healthier. Employers just simply need a way to lift the veil on the healthcare experience, so they can understand what they’re paying for and provide their employees with the support they need.

This is already happening and it’s occurring rapidly. The egregious cost practices plaguing the system will slowly be uncovered and years from now, the true costs of healthcare will be a couple of iPhone swipes away. But that alone will not solve the problem. Consumers will need to be taught how to navigate the system and how to “buy” healthcare. The United States is one of the leading nations in the world when it comes to consuming goods, but they will need to be “taught” how to consume healthcare properly and efficiently for this to work.

That means communication has to be simplified and presented in a modern fashion verses the confusion that has traditionally aided and abetted the situation. For example, an Explanation of Benefits (EOB) cannot require a PHD education to be able to discern and understand. In-network and out-of-network discrepancies must go away. Employers will need less vendors and instead choose more comprehensive platforms that can handle the bulk of their needs.  

Employees need support to make their way through the healthcare maze.
As employers move to more comprehensive solutions that simplify and lower costs, there is no reason to sacrifice the employee experience. There are people-friendly solutions emerging in the market that help both the employers and their respective employees become better consumers of healthcare.

Vendors have gotten smarter and are offering people-friendly models that provide employees with a transparent experience, so they can understand what to expect every step of the way. One example of this is a people-friendly reference-based pricing model, which includes negotiating pricing on the behalf of an employee and notifying them of the best price option for the best quality of care, prior to services being rendered.

A people-friendly pricing model is designed to provide the support and advocacy required to prevent any financial or legal harm to the employer or employee. In the end, this new model helps employees understand the cost of care – making them better consumers of healthcare.

It’s an exciting time to be in the healthcare industry. Issues like the lack of transparency and support that have been creating headaches for far too long, for everyone, are finally being corrected with innovative solutions. If you are headed to HLTH next week, you’re likely to catch a peek at many of the latest innovative healthcare solutions. You can also catch me at HLTH. I’ll be a part of the panel discussion on “Employers: Owning the Employee Experience” on Monday, May 7th at 3:40 pm PT.

Check out everything else going on at HLTH here.  

Why Brokers Need to Manage Their Clients’ Healthcare Supply Chain

By Cory Friedman, Vice President, Benefits Consulting, GCG Financial

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As business leaders, our clients know that procurement of goods and services is at the heart of good business practice, and most manage their supply chain with diligence to ensure suppliers meet standards for quality and affordability. Yet, most employers don’t view healthcare services in the same light, and with healthcare as one of their highest costs, they really should be.

In fact, most employers have outsourced the design and management of healthcare services to a broker, consultant or health insurers that have little incentive to improve quality or affordability. In doing so, employers lose control and expose themselves (and their employees) to the wasteful business practices embedded in healthcare and provider contracts. Why are so many employers disconnected from managing one of the most important and costly expenditures for their organizations?

Employers have delegated accountability for healthcare services to human resources, seeing it as a “benefit” rather than a service to be procured in an effort to maintain the health, well-being and satisfaction of their workforce. The end result is predictable: immense and costly variations in access, quality and safety.

The response to the rising cost of healthcare is often reactive (and misguided), passing a portion of costs to employees or shifting the burden of purchasing healthcare services to them through high deductible heatlh plans or health savings accounts.

Employers are in the healthcare business, whether they like it or not.
According to the National Business Group on Health (NBGH), which represents 420 large employers on health policy issues, employers project the total cost of providing medical and pharmacy benefits to rise by 5% for the fifth consecutive year in 2018, bringing the total cost to $14,156 per employee. If an employer has 100 employees, that means they’re managing a $1.4 million healthcare business. At 1,000 employees, their healthcare business is valued at over $14,000,000.

So, what are you doing to manage your clients’ multi-million dollar healthcare businesses?
In today’s ever-evolving employee benefits landscape, we, as brokers and consultants, have an opportunity (maybe even an obligation), to change the game and see ourselves as healthcare supply chain managers willing to challenge our clients to think differently. We have to change our mindset and work to disrupt the status quo.

Successful brokers are not helping employers hold down cost increases by raising employee costs, deductibles, copayments and coinsurance. Instead, they’re applying supply chain methods to healthcare purchasing.

Starting with a self-funded health plan, which gives employers the advantage of examining their data, the best performing companies are building plan designs that work best for their company, identifying targets of opportunity and creating incentives for employees.

When you examine the data, you’ll find wide variations in charges by hospitals. Reimbursements by private insurers can be as much as ten times higher than Medicare reimbursements for hospitals within the same geographic area. To address this, employers are designing health plans and creating incentives designed to encourage employees to use more cost-effective providers. For example, start with high-cost elective surgeries that have a wide variation in price and quality among providers: total joint replacement, spine surgery, cardiac surgery and bariatric surgery, to name a few.

You can put the brakes on rising healthcare costs, without compromising access to quality healthcare for your clients’ employees, with help from the right partners. Partnering with a solution provider that offers an innovative and personalized health plan management approach is key to helping your clients fight skyrocketing premiums.  Ask yourself, “Are you skilled in defending the status quo, or leading performance improvement to give your clients the ability to compete and win?”

Recently I spoke on a webinar, where we took a deeper dive on how some brokers are advising their clients to drive down costs. Click here to download, “Change the game: How employers are winning against skyrocketing premiums.”

Cory provides guidance and objective analysis of group insurance benefits and is currently responsible for the health insurance and employee benefit programs of more than 200 privately held organizations across the country. In 2016, he was selected as a Young Gun Award recipient by Insurance Business America, which recognizes young professionals making a significant impact in the insurance industry. Cory was also named a “Rising Star” in 2017 and 2018 by Employee Benefit Adviser, earning recognition as one of 20 advisers nationally age 35 and younger who exhibit quick thinking, openness to change, and the ability to navigate the ever-changing employee benefit landscape.