Being a community-first broker

By: Doug Hetherington, CEO & Program Architect at HealtH2Business

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For the past fifteen years, I’ve spent my career in the healthcare industry as a broker. I’ve spent my fair share of time advising employers about self-funded plans and population health management. It wasn’t until about ten years ago I had a somewhat devastating realization that if my current career trajectory continued, I may never be able to retire. I wasn’t worried about myself, but what about my children and grandchildren? Who was going to pay for their healthcare? Health insurance premiums were soaring, and something had to change. I decided I would start doing everything I could to truly make an impact.

The search for a solution.

The answers did not come from my fully-insured carrier representatives, but rather subject matter experts and innovative service providers in the self-funded industry. I found the flexibility within self-funded plan architecture to be the key to creating a true cost-containment solution. With the right vendor partners, self-funded plans offer nearly endless possibilities in plan design, risk transfer and mitigation, cost savings and member engagement. I quickly learned how boxed-in I had been by the limitations of traditional plan designs, networks and antiquated processes. My optimism around the future of employer-based healthcare dramatically improved.

Taking the word to the streets.

I shared what I was learning with clients and prospects and was pleasantly surprised by their willingness to listen, learn and even execute. The idea of finally controlling employee benefit costs was motivating to many business owners and their C-suite. However, this was a comprehensive and sophisticated concept that would require all stakeholders at the table. Two key strategies for success were inviting HR represenatives to participate in the discussion and exploration of what it means to be a self-funded employer. Getting the finance teams on-board to reinvest a portion of their savings back into the benefits plan in order to gain employee buy-in was essential. Basically, I did everything I had been trained not to do and it began to work. Employers were taking accountability across the leadership spectrum and employees were receiving better benefits for less.

Including providers in the benefits conversation.

Several years ago, I began to engage directly with providers and facilities that served my clients’ employee populations. Instead of pointing the finger and blaming them for high healthcare costs, I listened to their side of the story. I learned two very important things. First, healthcare administrators and providers are also frustrated with the way the healthcare industry is run. Their costs and prices aren’t going up as fast as deductibles and premiums, yet access, process and payment inefficiencies are becoming progressively worse. This only compounds the financial problem as a result of the fraudulent billing practices and the disparities in reimbursements between Medicare and commercial payers.

The second thing I learned from our discussions: healthcare wants to care. They want to be part of a sustainable, meaningful solution but given the current world of PPOs and networks, they are often unable to respond to local needs and provide innovative strategies to their communities. Once I had been enlightened in this it became easier to partner with my local healthcare providers because I knew we all had the same motivation – to solve a problem.

Creating a healthcare ecosystem that works for the community is essential.

I have since experienced on multiple occasions employers, providers, administrators and vendors at the table all working together for the common good of the community. I now focus on what I call the three pillars of success: provider, employer and employee. The goal is to assure what we create is financially sustainable and meaningful for both the provider and employer. Once that is solved, we then shift our focus on creating a great experience for the employee. Can you image what you could do if the financial piece was solved and providers and employers were working together for the benefit of the employee? Can you imagine what that could do for your community?

As a broker, I admit that I have sat in front of business owners and leaders and provided a complicated renewal spreadsheet with a large increase and asked them to choose the column that sucked the least. I’ll never do that again. While I have nothing but optimism and respect for healthcare and the broker industry, I choose community and will continue to choose my community.

I recently spoke with Maestro Health on this very topic. Click here to download the webinar and learn more.

Taking Action: Using data to fight high costs and low quality in healthcare

By Scott Bennett, Vice President of Access Innovation

Featured in BenefitsPRO’s Broker Innovation Lab

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When it comes to helping clients get more out of their health benefits, the richest insights come from robust data sets. While most brokers & consultants know the power of robust data, they don’t always know where to seek it out, or what to do once they have data sets in hand. Here’s a couple of frequently asked questions innovative brokers & consultants can reference when helping clients drive down costs and improve health outcomes for their clients’ employees:

How can I pull cost and quality data on providers in order to help clients make informed decisions about where to direct care?

A number of data sources are downloadable from Medicare’s official website and tutorials on how to analyze datasets on the Medicare Research Data Assistance Center Website (RESDAC). However, there are a few healthcare companies that take this public data and organize it into decision support tools for cost, quality and market analysis.

Let’s say you want to gather more information for your clients on a cost-intensive procedure like an MRI. A third party administrator (TPA) can help identify any costly referral patterns. With the proper data from a TPA, you can help clients reduce costs by finding if there are cheaper referral options available. With the right cost transparency tools, you can draw direct connections for employers to these beneficial partners.

Maestro Health™ makes its own proprietary insights dashboard—the RBP Insights Tool—available to premier industry partners. This tool helps foster innovation and continue conversations that can inform and benefit a self-funded employer.

Is there a resource I can use to compare commercial cost data by region?

A recent RAND study released commercial payment data on hospitals all over the nation, which now allows for a complete comparison across many regions at one time. This RAND data combined with federal quality data, hospital cost data and Medicare-average payment data can equip a self-funded employer with the same benchmarks previously only available to large employers and major carriers.  These benchmarks allow employers to review their present network arrangements and work with receptive providers to negotiate from a position of knowledge with objective criteria. Further, when providers choose not to enter into a reasonable agreement with an employer, this data could support out-of-network negotiations. 

How can employees take a more active role in their healthcare so they can avoid low quality, low-cost hospitals?

To strengthen their high-quality care networks, self-funded companies can use aggregated data to help identify providers that stand out for cost and quality in their geographic area.

A self-funded plan that utilizes a TPA can incorporate cost/quality transparency tools with built-in plan incentives so employees can take a more active role in care navigation. If your client is using a network, there may be more of an opportunity to provide steerage and incentives within that network due to recent case law and settlements between the Department of Justice and large hospital systems. In these settlements, anti-competitive steering restrictions have been removed from many hospital contracts with carriers. Without these restrictions, employers could allow their employees to learn about and seek care from more cost-efficient healthcare providers inside of a network.

Securing access to quality data is easier said than done for many brokers and consultants who work with traditional health plans. But by understanding the benefits of rich data, brokers and consultants can make a major impact on clients’ bottom lines.

 

Don’t leave money on the table: how small employers can save with self-funding

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When it comes to self-insurance, the question isn’t should employers self-fund their health plan—it’s why haven’t they already? Self-funding is one of the most effective ways employers can gain control over their healthcare spend and provide better benefits to their employees.

But not everyone is comfortable with the risks associated with self-funding. That’s where captives come in. Captives can accommodate self-funded options for employers with as few as 50 employees on the plan. If an employer has more than 150 employees on the plan and several years of good loss-ratios, it’s hard to think of a reason not to self-fund. If their medical loss ratio minus high claimants is consistently greater than 90% (assuming they can get that data from their health insurance carrier), that’s one of the few times it makes sense to stay fully-insured.

The percent of large employers who self-fund their plans rose dramatically between 1999 and 2018. But this number stayed relatively flat when it comes to mid-sized employers. It’s not that self-funding makes less financial sense for mid-sized employers, it’s that they have not been told, and therefore don’t yet understand, the long-term risk and reward of self-funding.

With self-funding, an employer pays an administrative fee to have an insurer or TPA administer their health plan (deal with providers, claims, etc.) and a premium for stop-loss insurance to protect them against large claims costs.

The big difference is employers pay their own claims—meaning they get to see every claim and know exactly where every dollar is going when it comes to their healthcare spend. And they no longer pay the hefty margin above claims costs that carriers bake into their fully-insured premium. Over a multi-year period, the savings are significant.

One of the biggest myths in health insurance.

Typically, employer health plans experience one year out of every five where claims are abnormally high. Many employers are under the impression that a fully-insured plan is less risky because the carrier will absorb or pool these high claims and cushion the employer. This is one of the biggest myths in health insurance.

The carriers do not “absorb” these costs; they recoup them by raising premiums the next year—sometimes by 30% to 50%. The employer is cushioned from the high claims costs only in the year they are paid. They get hit with them the following year in the form of a premium increase. When claims costs come down, though fully-insured premiums rarely do, rate increases are based on the new, higher baseline premiums.

With a self-funded health plan, the employer will pay a portion of the additional costs during a high-claims year and stop-loss insurance will cover the rest. When claims costs come down in following years, so will the employer’s costs. The stop-loss premium may increase, but nowhere near as dramatically as a fully insured premium would have. The employer retains the margins above claims costs rather than giving that money to the fully insured carrier.

Added stability and control.

Self-funding in a captive provides an extra level of protection against volatility and premium increases. The risk pooling solution dampens the volatility of claims costs during the high-claims years and even enables employers to get a portion of the stop-loss premium returned in good years. In addition, as members of the captive, employers have group purchasing power when negotiating stop-loss renewals, which helps to lower premium increases.

Self-funding in the captive also enables employers to take advantage of claims reduction programs. Some captives provide the following: leading population health analytics and predictive modeling to drive effective disease management programs, a cost-effective, transparent Pharmacy Benefits Manager and an innovative specialty drug program to rein in spiraling drug costs.

Captives make it easy and effective for mid-sized employers to enjoy the same benefits of self-funding as large organizations. Employers have saved hundreds of thousands—sometimes millions—of dollars over the years by self-funding in captives. That’s money that can be reinvested in better health benefits for the employees.

Hear more about captives during Maestro Health’s webinar, “Breaking the stereotype: Why self-funded captives are here to stay,” on Tuesday, August 6 at 1 PM CT. I’ll be joining Richard Armstrong of Springbuk and Scott Bennett of Maestro Health for a great conversation on what to look out for when building a captive strategy. Register here.

What healthcare should be

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We can all agree on one thing: The current U.S. healthcare system is broken. Many employers have little transparency into why their premiums are increasing year over year at an unsustainable rate. Employees, as a result, are unable to afford the rising costs associated with healthcare. Brokers and consultants, who serve as the conduit between health plan administrators and employers, have to deliver the bad news to clients again and again. The healthcare landscape is shifting to a model where excessive payment and lack of transparency is the status quo. The industry is riddled with fraud, waste and abuse. But this is not what healthcare should be.

In an effort to do something about this paradigm shift and truly reclaim control of healthcare, many employers are turning to modern self-insurance models. With an innovative approach to self-funded benefits, we can get back to what healthcare should be—people managing their own healthcare decisions, efficiently controlling their costs and experiencing better health outcomes.

People before profits.

Before we discuss the solution, let’s unpack the issue. In the U.S. today, medical loss ratios (MLRs) restrict the amount that insurers can spend on operational expenses and require they spend 80-85 percent of premium revenues on claims activities. At their core, MLRs are designed to force insurers to overcharge for claims in order to maintain a profit. It’s no wonder Americans remain overwhelmed by the high cost and complicated process of claims billing.

That said, prices don’t have to be sky-high for providers to receive a fair-market reimbursement, and employers can decrease price tags on healthcare for both their organization and employees. This is where a reference-based pricing model for self-funding comes in.

When done correctly, reference-based pricing is a core component of a people-first benefits strategy. This type of model provides employers and employees with lower and more accurate cost of care by leveraging an existing cost baseline (e.g. Medicare) to make a more educated and fair market payment. With this strategy, healthcare providers are still allotted a profit via a percentage interest. However, these profits are not as inflated as typically found amongst reimbursement models today.

A transparent, easy-to-navigate experience.

The healthcare industry touts the importance of giving us better access to care but aren’t arming consumers with the tools and education they need to do so. The truth is, the healthcare industry is nearly impossible to navigate. Consumers are often confused about where to go for care, what reasonable price points look like and which health plan design is right for their situation. When they’re confused, they avoid getting the care they need and employers’ healthcare costs continue to rise.

Employers must help their employees navigate the complex health system to deliver better outcomes and lower costs. To do so, employers must go beyond communication and market to their employees – it’s no longer enough to just tell them what they need to know. The right partner with access to the right tools can do just that, establishing the transparency and support employees so desperately need to navigate the healthcare system. Employers need benefits partners who offer real-time communication support and robust tools that not only ensure a fluid user-experience but also maximizes transparency, so employees understand where to find the best quality care for a low cost.

Holistic, always-on communication.

It’s no surprise that employees are poorly informed about their benefits. Most health plans only connect with employees during qualifying events such as on-boarding, open enrollment and major life changes. What consumers need is continual and simplified communication to make sure they are engaged and informed about their benefits as early and as accurately as possible.

For example, let’s say you have an employee who leads a somewhat sedentary lifestyle, primarily eats meals out and is overweight. By engaging with that employee throughout their employee lifecycle, from on-boarding, to onsite biometric screenings, to personalized nurse coaching, a pre-diabetic diagnosis can be caught early on.

Without a full understanding of your employees’ health and wellness history, employers run the risk of an untreated and unhealthy population that can significantly drive up costs.

With an innovative and integrated approach to care in a self-funded model, employers can implement preventive care and frequent check-ins with employees to avoid future costs and improve health outcomes. Self-funded strategies allow the employer to essentially become the insurer and assume the responsibility and risk for employee claims, therefore making it in their best interest to help employees find their healthy and stay healthy.

We are in a defining moment when it comes to the future of healthcare in the U.S. By providing employees the tools and touchpoints necessary, employers can positively impact both their workforce’s health and wealth. If more employers could empower employees to take better care of their overall wellbeing and give them access to the best tools to do so, we as a nation could start to chip away at the broken healthcare system. Affordable, understandable and accessible: that’s what is truly empowering, people-friendly and what will help bring humans back to the forefront of the healthcare system. This is what healthcare should be.

Here’s how we’re arming brokers, consultants and employers with the tools needed to reclaim control of healthcare.

Mic Drop – Maestronite Culture Continues to Shine

Maestronites recently experienced a pretty proud moment after making it on Fortune’s list of The 55 Best Companies to Work For in Chicago. We love adding to our growing list of award wins, but this one is especially meaningful to us because it is based on feedback straight from our employees.

It starts with our core values.

Sure, any company can paint their core values on their wall and call it a day. But Maestronites live and breathe our core values: biz-love, fun, teamwork, kindness humility, urgency, bold thought and honesty. They’re celebrated through things like charity initiatives, kindness cards, parties, over-the-top birthday desk decorations and far too many Seinfeld references.

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It doesn’t stop there.

Maestronites come from many walks of life. They live all over the U.S., in one of our four office locations or remotely. Together, we’re working toward the common goal of transforming the healthcare industry. We build on that same passion while still embracing our miles in distance and diversity in our employee population base.

But, don’t just take our word for it.

Here’s what a few of our Maestronites have to say about the culture at Maestro Health.

“Everyone is willing to jump in and help with things, even if it’s not their department.” – Albert Ellenich, Senior Experience Designer

“Our leaders serve their teams and help row the boat!” – Chad Lilly, Director of Recruiting

“I get to work with people who really care about the work they do. – Luciano Pereira, Software Architect

Clearly, it doesn’t take public accolades for us to get the warm fuzzies for the culture at Maestro Health. 

Interested in joining a company with a culture like ours? We’ve got good news. We’re hiring at all four of our locations – Chicago, Charlotte, Detroit, Orlando – and we have remote opportunities available. Check it out.  

Five years of people-friendly benefits & counting

By Rob Butler, Chief Executive Officer

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The decision to start Maestro Health and make employee health and benefits people-friendly again was driven by several factors: to help simplify healthcare for everyone involved; to enhance the experience of receiving care; to give employer HR teams the best possible support and help them do right by their employees; to bring more transparency to the benefits process so that employer and employee actually understand what they are paying for. What a concept, right?

So, we set out to create the most experienced employee health and benefits startup by hiring and acquiring industry experts who share a mission to make employee health and benefits people-friendly again. Five years, four locations and an acquisition by AXA later – here we are.

Along our journey of simplifying and personalizing how employees shop, enroll and live with their benefits, we have remained open to finding the best ways to bring this vision to life. We’ve doubled down on the technology. We’re enhancing our service delivery model to further our tech-meets-service approach. We’ve brought on the most talented and driven people to tell us what we’re doing right and when we’re making mistakes. We’ve stayed committed to the transformation of the U.S. healthcare market. And we don’t plan on stopping.

The Next Generation of Healthcare

I’ve said this repeatedly and I’ll say it again: the U.S. healthcare industry has not only reached its tipping point – its already in the transition stage. While it’s the largest healthcare market in the world, it is plagued by inefficiency, high costs and misaligned incentives. It’s a trillion dollar industry, yet the U.S. has some of the worst health outcomes when compared to other high-income nations. It’s not a sustainable pattern and a change is well overdue. 

Last year we took a huge step forward in our strategy to transform healthcare in the U.S. by joining forces with AXA, a worldwide insurance leader. AXA chose to partner with us to tackle the broken U.S. healthcare system because they found we are truly unlike any other offering on the market. We bring a deep knowledge of the healthcare industry and share our passion to empower people to reduce their healthcare costs while maintaining or improving outcomes.

This partnership enables us to bring new products and services to market faster; offerings designed to further reduce healthcare costs and improve engagement for constituents across the entire continuum of care. With AXA’s global capabilities and knowledge of providing different types of insurance and services across borders, we view this move as a gateway to global health benefits technology.

A Vision for the Future

At times, it feels like the number of companies, big and small, entering the healthcare market is endless. They all claim to have the magic recipe for solving the broken industry. A real solution is going to come from a company whose sole goal is to lower healthcare costs and put the consumer first – not a company that is adding another offering to its roster to impress shareholders.

Truly changing the U.S. healthcare market will be a challenge. It requires an integrated, modern approach, innovative technology and an open mind about different care models, such as modern self-funded solutions that create healthcare ecosystems. That’s what we’ve been spending the past five years building at Maestro Health and will continue to build in an aim to put the control of the healthcare industry back in the hands of consumers. 

I would be remiss if I did not end with this: People are at the core of what we do. Our Maestronites are the reason we are successful, and the reason our mission transcends our multiple office locations. As we move forward in our fifth year as a unified brand, I feel fortunate to be a part of this team.

Closing Out Professional Wellness Month with Some Totally Not Boring Tips

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Sure, June marks the start of summer. But June is also Professional Wellness Month. Sounds boring, but it doesn’t have to be. That’s why we had a quick mCHAT with our totally not boring CHRO Sheryl Simmons and asked her to share some practical tips you and your employees can use to improve health and wellness – not just this month but all year long.

What do you think is the most valuable takeaway for Professional Wellness Month?

First and foremost, don’t get hung up on the outdated ways people used to look at wellness – think instead about your employees’ overall wellbeing. Wellbeing efforts should address the person as a whole, including their physical, emotional, social and financial status. Because let’s face it, things like stress levels can have just as big of an impact on your health as the number of steps you take in a day.

What are some tips HR professionals can share with their employees to help them maintain their health and wellness while at work?

  • Encourage employees to get away from their desks to enjoy their lunch. Reiterate that it’s okay to sit outside, in the office kitchen or to grab a conference room with co-workers. The main goal is for them to get away from their desks, give their eyes a break from the screen and to give their minds a chance to rest.

  • Remind employees to drink lots of water throughout the day, especially in the hot summer months. They should shoot for half their weight in ounces. Take it a step further and start an office water challenge with a prize for the employee who guzzles the most H2O (keeping in mind the safety risks of over-consumption).

  • Limit caffeine intake. This is a tough one for me since my blood type is French Roast. However, I try to drink one glass of water for every cup of coffee I drink. This can also work for soda drinkers.

  • Encourage your employees to take small breaks throughout the day, get up and stretch or take a quick walk. This will help with both physical and mental health.

How can HR make sure to educate employees about what they should do to stay healthy?

Above all, it’s essential that employees are able to read and understand their health benefits. If you are looking for a quick and easy way to help them boost their understanding of insurance basics, send them to the FAIR Health Consumer site. It’s an independent, non-profit organization providing fair and neutral healthcare information including things like a cost estimator and information to help better understand your healthcare bill.

What are some resources HR professionals can share with employees who are looking to improve their physical health?

 

Inc – Wellbeing vs. Wellness

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By now, most employers understand that wellness needs to play some role in their employee engagement strategies. But wellness as we currently think of it falls short. While fitness trackers and healthy snacks programs are good steps forward, there’s more to be done. 

We need to move away from thinking about wellness and think instead about overall wellbeing. Most wellness initiatives today focus on a person’s physical health, not their overall wellbeing, which can lead to lack of engagement and wasteful spending. An effective approach to overall wellbeing begins with understanding the barriers that employees face in their everyday lives that prevent them from finding their healthy.

The following three components are key to overall wellbeing: 

Physical Health: Having the health and energy to get things done on a daily basis.

  • While this is the most obvious component of employee health and wellbeing, it should be noted that traditionally healthy choices and actions help us avoid preventable chronic conditions. Chronic conditions can ultimately affect your financial health (medical bills/debt) and your emotional health (stress). Employer-sponsored benefits and wellness programs that drive education and engagement are critical components in driving physical health. Employees need to understand how and when they should access healthcare to ensure they remain on track to achieving their heathy. For some, it may be hitting 10,000 steps on their Fitbit, while others would like to see a decrease in their A1C levels.

Financial Health: Effectively managing your economic life.

  • Physical health affects financial health and vice versa. An employee – even one with a moderate salary and benefits – may be unable to afford or access care, healthy food options and more. Similarly, an employee who can’t cope with financial pressures at home may develop health issues down the line. Employers should offer employees access to financial services and resources to help them understand and overcome financial obstacles.  

Emotional Health: Being able to cope with the ups and downs of life without it impacting your day-to-day.

  • Emotional wellbeing is impacted by both financial and physical health, so employers should not overlook it when establishing their programs. Employers can offer mental health services like mental health days, Employee Assistance Programs and even mindfulness incentives to encourage employees to take care of their emotional health. 

Bottom line: Employers play a huge part in their employees’ overall health and wellbeing; and ultimately, they’ll feel the impact if something is wrong or goes wrong. Physical, financial and mental health are all intertwined and must be addressed if you want to have better outcomes and productivity while lowering costs.

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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