Employee benefits

Top 7 Employee Engagement + RBP Questions & Answers


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.

The AXA Acquisition: Behind the scenes

By Rob Butler, Founder

Rob butler, maestro health

As you may know by now, Maestro Health has been acquired by AXA. It’s been hard to keep the news to myself especially when you take pride in leading a company with an open book-type culture. So, when you know your company is about to take a huge next step in their mission to transform the U.S. healthcare industry, yet you’re unable to share your excitement until the appropriate moment, it’s tough. So, now that I’m able to, I’d like to share the behind scenes events that has led to this momentous occasion for Maestro Health.

As a privately-owned company, acquisition was always an inevitable outcome.  However, this happened way before anyone imagined it, and frankly, fell into our lap. This was not in our plans, nor was it on our radar. I actually took the first meeting with AXA last spring on a recommendation from a friend. Since that meeting, a pretty interesting chain of events occurred – one that culminated in Maestro Health being acquired by a French company that happens to be the largest insurance company in the world ($100 billion in annual revenue, in euros, that is).

Wow. Just writing that number is a bit mind boggling.
It’s kind of cool to think that after only four short years since its founding, Maestro Health is now part of the AXA family— an international company that operates in 64 countries and has over 1mm clients. What an opportunity for both our employees and clients.  

Acquisitions by large companies like this don’t always feature great outcomes for all the key parties such as clients, employees and management teams. Many times, it will be a good thing for some of the key constituents, but rarely do all the parties have favorable outcomes. We CEOs stand up in front of our employees, clients and partners and ensure them that all will be OK, and sometimes it is – but, frankly, sometimes it’s not. 

This one just made too much sense to say no.
Imagine. If you were in my shoes and sat down over the course of three months and discovered the 42nd most recognizable brand in the world shared the same vision, strategy, culture and aspirations as we do – to ultimately transform the U.S. healthcare market by simplifying the experience, lowering costs and empowering consumers—or what we call “making health and benefits people-friendly again.” And then, to top it off, you uncovered they were seeking to enter the U.S. market with a continuum of care model that truly empowers consumers in making the right healthcare decisions—exactly what we have. If you are like me, when I first heard it, I didn’t believe it. So, I listened closer. And it got better. They also recognized that the HR profession wasn’t meant for professionals to be bogged down in paperwork or disparate systems that left them no time to build teams or support their employees. In addition, they saw that the current system of health and benefits is not setup to truly empower employees (consumers) to lead healthier, happier and ultimately, better lives—inside and outside of the workplace. I was now thinking this could be very interesting. And then the final piece. They looked at our comprehensive platform, maestroEDGE™, and knew this was exactly what was needed to turn the U.S. healthcare industry upside down.

I must admit, even with all the proverbial stars aligning, I still just wasn’t sure. When I started Maestro Health, I did so by hiring and acquiring the most talented and driven people I could find who shared our vision and mission to make employee health and benefits people-friendly again. We built this company with a lot of long nights, hard work and determination—and have had a ton of fun along the way. I needed to make sure this partnership would be in the best interest of those wonderful people that have become my second family.

That’s when I knew for sure.
AXA has no team in the U.S. to run Maestro Health, nor any desire to do so. They insist we stay long-term and run the company. When I heard that, and fact checked it, I knew. Here was my chance to keep our team and employees together for a long time to come. That’s exactly what I was looking for and maybe the most important factor in considering an opportunity like this. There is so much we want to accomplish and keeping the team and employees together is vital to that success.

Besides our employees, clients win big too.
I’m thrilled that we will eventually have a breadth and depth of products and services that most others cannot provide – with the same people and same service teams our clients know and trust. And of course, going from the most experienced startup to now being a part of the 42nd largest brand in the world (and the number one global insurance for eight consecutive years) will provide even more reassurance to our clients that we have long-term financial viability dedicated to the long haul. Plus, being a standalone subsidiary ensures we won’t get lost or stifled with corporate bureaucracy and lose our entrepreneurial spirit, which our clients appreciate so much. We are going to get our cake and eat it too, which is pretty rare, in my experience.

Thomas Burberl, AXA CEO, visited the U.S. and invited me to sit down and talk. I’ve had the privilege of meeting several Fortune 500 CEOs. Thomas, by far, is the most genuine. He wants to make an impact in the U.S. and the lives of every healthcare consumer—and he is committed to doing so. He said he heard we had a great team (I’m biased, but yes, I believe we do), and he asked me if I would stay and run the business. I shook his hand on that day and promised to do just that. I intend to keep my promise.

This is going to be a fun ride.

Click here to learn more.

Where's Maestro?

By Rob Butler, Founder

May we first send our thoughts, support and best wishes to the city of Las Vegas for the recent horrific tragedy. Sure seems like our blog takes second precedence in the sheer scope of things.

Speaking of second precedence, you might find yourself feeling like something is missing this year. Yep. You won’t see our glowing yellow booth.
You won’t see the sessions recorded by our digital doodle artists.
And unfortunately, we won’t be hosting our rooftop party, like we had last year.

While last year’s conference was nothing short of incredible, this year, although HR tech is important to us, another precedence has emerged. Clients, clients and more clients.

People got bit by the Maestro bug last year and since then we have been busy onboarding and taking care of business (Bachman-Turner Overdrive for all those in my generation). We’ve also been partnering with key channel partners as well like Aflac, Allstate and Pear Benefits, while adding over 100+ new employer clients including some really cool ones like HDR. We’re investing time and resources to combat their administrative headaches and support HR by customizing new HR suites that fit their unique needs.

We have promised both our employer clients and our channel partners a “we’ve got your back” service experience and we meant it. Never wanting to be thought of as just a vendor who simply “sucks less,” we hire people who have a passion to make employee health and benefits people-friendly again. We’ve beefed up our customer service and operations with 48% net new hires year-to-date. They act as an extension of our clients’ HR teams, providing full transparency every step of the way.

And, it’s not just the people answering the phones who display this passion for service. Last month, our tech team persevered through natural disasters and worked diligently to release the latest version of maestroEDGE™ and (me)BILLING ADMIN™ for our clients on time, despite our Orlando office being affected by Hurricane Irma.

So yeah, we support and love HR Tech, but our clients come first. You won’t be seeing the big, yellow booth this year, but you can still visit us at our (scaled down) booth #2452 at HR Tech or check out what we’re up to at wheresmaestro.com.

Heads Up: Quick Reminder on 2017 ACA Requirements

By Sheryl Simmons, Chief Human Resources Officer

“Repeal and Replace” has become a daily staple of our national newsfeeds. Our blog sites, Twitter streams and LinkedIn feeds continue to swirl around the current state of the Affordable Care Act (ACA). Regardless of the chatter and possible outcomes, employers still need to look at their current operating strategies to make sure they’re ACA compliant. As much as employers were looking for a modicum of ACA reporting relief, it didn’t happen. The looming ACA requirements are still the law of the land.

One such requirement is the deadline for using the new Summary of Benefits and Coverage (SBC) template, which is now. The SBC instructions state that these new templates must be used beginning on the first day of the first open enrollment period that begins on or after April 1, 2017, with respect to coverage for the plan years beginning on or after that date. This applies to all fall and January 1, 2018 plan years.

If you’re feeling uneasy about the state of your ACA compliance, check out the following information shared by the Centers for Medicare & Medicaid Services (CMS), here. And, don’t forget, our (me)ACA SERVICES™ may be able to help with everything from data collection to form distribution. Check out how we helped the University of North Carolina (UNC) nail ACA reporting in our case study, “Conquering Compliance: How UNC did it in less than six months.”

Hello, Ben Admin 2.0

By Nancy Reardon, Chief Product Officer

Benefit administration, private exchange, enrollment, online shopping – no matter what you call it, employers are looking for stronger solutions to help their businesses adapt to new marketplace realities. The largest component of this new reality is the changing needs of their workforce.  

Effectively managing and engaging your workforce will help drive your business forward and ultimately improve the bottom line. For HR professionals to achieve this success, a new approach to managing benefits, which attracts and retains employees, is now a necessity.

Hello, Ben Admin 2.0.
Over 25 percent of benefit decision makers expressed that they thought benefit administration systems were only “partly” integrated. Well, things have changed. Benefits administration and private exchanges have converged to create Ben Admin 2.0. After all, technology and service go hand-in-hand, and you shouldn’t have to settle for less than the best of both. Ben Admin 2.0 delivers a personalized employee experience and a powerful backend—coupled with an upgraded service experience to ensure you and your employees receive the level of support you deserve and expect.   

Benefits are important to employees, yet 80 percent of companies report low benefits knowledge amongst their employees. The fact is, employees need a simple way to understand and effectively manage their benefits. Ben Admin 2.0 is designed to offer a hyper-personalized, comfortable experience, marrying both tech and service, that takes the “scary” out of the process and empowers employees to manage their benefits with confidence.

Of course, this technology not only needs to look “pretty,” but it also needs to deliver functionality that provides you with the peace of mind knowing that your benefits program is running true to your company’s vision and strategy. The good news is that Ben Admin 2.0 is a modern and simple way to administer your employee benefits without unnecessary features that overcomplicate and are impossible to navigate.

For instance, (me)BENEFITS ADMIN 2.0™ was designed to make managing tasks (i.e., processing changes in marital and dependent status) more intuitive. Now, life events and other changes like these can be made automatically and accurately. It also recognizes that each employee’s benefits knowledge and personal preferences are different. (me)BENEFITS ADMIN 2.0 provides decision entry points to meet your employees where they are by providing “doors” to help them navigate to the best plans. Employees choose their preferred path to finding their best plans through the use of such tools as Shop by Doc™, mSCORE™ and the “show me all plans” options.

It’s so much more than an upgrade in technology.
No doubt, there has long been a need for an update in HR technology. In fact, a recent Maestro Health™ study found that 27 percent of HR professionals want to say a final “goodbye” to systems that don’t talk to other systems and 16 percent are ready to get rid of their never-ending paperwork and lack of automated processes. But it takes the right partners to fill the gap when it comes to service, too. With Ben Admin 2.0, the concept of tech or service has been thrown out. It’s all about tech AND service. In fact, tech-meets-service is the norm for Ben Admin 2.0.

Ben Admin 2.0 providers don’t consider themselves to be just a “vendor.” They approach Ben Admin as a partnership and consider themselves an extension of your benefits team. This tech-meets-service approach includes dedicated account managers and client service teams that are available year-round, not just during implementation.

You no longer need to simply settle for a technology vendor. Instead, you can now choose a partner that effectively demonstrates both tech and service. A partner who collaborates with you in managing your employee benefits program.

Why this upgrade matters to HR.
Your world is changing—with constant legislative changes, rising costs, the growing popularity of High Deductible Health Plans and increasing expectations of your workforce—you need benefit administration technology and a partner who recognizes and embraces these changes. Doing so will effectively position your benefits program and your business for success.

As the role of HR professionals continue to evolve from transactional to strategic, you need a solution that enables you to leverage your most important asset—your talent. Ben Admin 2.0 brings all the tools you need together for you and your employees at one destination for managing their overall health and financial well-being.

The new era of Ben Admin has arrived, and it’s ushering in a new approach for HR technology to solve long-standing HR hassles. If you have questions, you’re not alone. Join me on June 6, where I’ll be answering questions alongside Carrie Marquardt, Benefits and HR Solution Practice Leader, Maestro Health. 

Goodbye, Complicated Ben Admin

By Sheryl Simmons, Chief Human Resources Officer

Sheryl Simmons discusses ben admin

Benefits Administration has had a reputation for far too long of being complex and confusing – not just for employees, but for HR professionals too. How did that become acceptable as the status quo? Employers have been manually processing eligibility changes. They’ve struggled with Benefits Administration (aka Ben Admin) platforms that promise to make their lives easier but, in reality, are navigational mazes. In this day and age of technology, HR deserves better. If you’re still doing it old school, it’s time to say goodbye.

Later, mountains of paperwork.
Last year, Maestro Health™ conducted a study asking HR professionals where they spend most of their time. The number one response – processing administrative paperwork. If you’re an HR professional, you’re well aware that an abundance of time is not a luxury we have. Yet, we continue to trudge through manual processes that lead to headaches, along with creating a frustrating experience for employees.

We know employees are also ready to ditch these paper-based methods. HR pros know that handing over a stack of forms to new hires for completion on day one is not an ideal start to onboarding. “Welcome to this fantastic new career opportunity. Please fill out this pile of paperwork, and make sure your writing is legible so you don’t have to fill them out twice.” How’s that for a warm, fuzzy welcome? In fact, 69 percent of employees will likely remain with a company if they experience what they consider a great onboarding process. That stat alone is enough for savvy HR pros to say a final goodbye to paper processes.

See you never, complicated Ben Admin systems.
I often compare signing a new Benefits Administration vendor to being setup on a bad blind date. Your hopes are built up by the recommendations of others and the promise of a great experience, only to get a dose of reality when your date shows up and they’re nothing like what you expected. Check, please!

The myriad of features that sounded so great when they sold you a high-tech experience turns out to be difficult to navigate and not customized to your HR needs as promised. Employees are frustrated with the cumbersome enrollment experience. Your boss is questioning your judgment for buying the system. And you’re left wondering why you didn’t just stick with mountains of paperwork. If this is hitting too close to home, don’t worry – you’re not alone. In that same Maestro Health study I mentioned earlier, we asked HR professionals to name their biggest headache. The top answer – disparate systems.

Ben admin solutions

With the constant legislative changes and ever-evolving landscape of healthcare in general, we shouldn’t have to deal with systems that can’t keep up nor make things more complicated than they need to be. HR tech vendors shouldn’t be pulling the bait-and-switch on us. A few weeks ago, I told a vendor, “Could you just not suck?” True story. HR professionals need business partners – not vendors. We need HR tech solutions that are willing to partner with us to simplify the already complex world of benefits, specifically ben admin, not sell us even more complicated systems. 

Goodbye, Ben Admin as you know it.
I think it’s safe to say that the traditional methods of benefits administration just aren’t cutting it anymore. At one time they were appropriate –  but so were floppy disks and cassette tapes. But times, they are a changing. So enough already. It’s time for Ben Admin vendors to stop acting only as a “vendor” and deliver on their promised partnership to ease the burden on HR professionals and creating a consumer-like experience for employees. Skip the bad blind date. The next generation of Ben Admin is coming this spring and it’s not just a vendor – it’s your new business partner. Be among the first to see it when it arrives.

4 HR Tips From A CMO

By Lauren Metsig, Chief Marketing Officer

Employee benefits play an important role in our lives. But let’s be honest, they have a bad reputation for being incredibly complicated (and boring). When people hear they need to make a policy change, review new options or choose a new plan altogether, eyes immediately begin to glaze over.

As a marketer, I desperately wanted to change that. I knew there had to be a way to strip away the complexity and humanize the benefits process in a way that helps people understand it. After all, most consumer brands have mastered the art of connecting with consumers in ways that are entertaining and emotionally engaging. For ages, marketers have found ways to make the most snooze-fest topics, somewhat interesting. Because, that’s our job as marketing professionals—to get into the minds and hearts of our audiences and find a way to speak to their pain points. There’s no reason why we can’t do this for employee health and benefits.

Over the past few years, I’ve worked with many HR leaders in producing employee communication campaigns (that actually work!) on all types of benefits-related subjects—from FSAs to general open enrollment. Below are four tips I’d recommend to HR professionals interested in thinking more like a marketer when it comes to engaging their employees (with benefits communication and tech).

WARNING: About one minute into the below, you will probably start thinking "who has time for this, Lauren?  Who has the staff or the resources for this?  Lauren, you're off your rocker."  And that's where your vendors and creativity come in to play.  First, always ask your vendors to help (because they should be willing to help you).  Second, just start with adopting one "tip" and try to integrate it into your next communication plan--and then, build from there.   

1 Focus on the experience.
The first step any marketer takes before tackling a new campaign is to consider the best way for your audience to digest the information you want them to see. Of course, as an HR professional you likely already use tactics like posting information in high-traffic areas, like break rooms or near time clocks. However, since no one really looks at those 8.5 x11 posters on the bulletin board, you’re probably not getting the results you want—that’s when a multi-channel approach becomes really important. 

This means thinking about how your people prefer to consume information. If your organization is “email happy” and sends way too many emails for everything, then you probably don’t want to use email as your only source of communication. One of the quickest ways to get information to your people is through their phones. After all, if you look around, you’ll see it’s not just millennials who have their eyes glued to their smartphones – it’s everyone. In fact, a recent study conducted by the Pew Research Center, reported that 77 percent of Americans now own a smartphone, with adoption quickly rising amongst people in lower-income households and adults over the age of 50. By using a simple text messaging service, like EZ text, you can quickly send a message to your people to remind them of benefit meetings, open enrollment and even wellness tips. You can also include a link to a form or open enrollment website to further the engagement. 

The experience of consuming information and education goes way beyond communication channels—it also includes your HR technology, like your benefits enrollment experience. If your enrollment is online, you should be asking questions like—Is it intuitive?  Does it provide your people with easy-to-understand decision support tools? And if your employees are still enrolling on paper, then I would highly recommend you switch to something online—for your sanity and the sake of your employees’ experience.

2 Data, data, data.
HR professionals have access to a wealth of employee information. (If your company is self-funded, your vendor can provide you with even more information, so don’t be afraid to ask for what you need.) Dig into that data to segment your audience and craft a communication plan that speaks directly to them. You can use this data to fuel personalization of your campaigns, messages and technology.

For example, if find you have a significant employee population that is married, chances are they may be making their benefits decisions with the help of their spouse at home. Consider creating a communications strategy that also engages their spouse through direct mail (…and no, snail mail is not dead. You just need to use it strategically). Try sending them a postcard at home with open enrollment information or reminders to use their benefit accounts—then you're not relying on your employee to share all the communications to their spouse.  

If you find yourself thinking, “Well, I don’t have a data analyst to help.” Don’t worry—ask your vendors to help. Often, your benefit vendors will help you segment your population at no cost. If that doesn’t work, then ask your employee population what they want using a service like, SurveyMonkey. It’s a really simple tool to figure out how your employees like to communicate, what they like about their benefits experience, and what they don’t.

3 Get personal.
Use the information you discovered in your data to your advantage when communicating and personalizing the enrollment experience to make it more dynamic, rather than repeating the same messaging to each employee. One option is to make the path through online enrollment dynamic, shaped around your employees’ demographic and health needs. If you have a segment of employees that typically opt for High Deductible Health Plans, consider presenting them with benefit accounts (HSA/FSA) information earlier in the enrollment process, such as near the voluntary offerings. Also, try personalizing decision support and just-in-time education in a way that makes sense to the enrollee during the election process—if you make multiple tools available, each person can choose a path that works best for them. (Once again, ask you benefits administration vendor or broker for this!)

This kind of personalization during enrollment and beyond will help build an engaged audience from the onset of the benefits year. Not only will your people be satisfied and happy during enrollment, but you will receive less questions and headaches throughout the year.

4 Make it human.
Again, as an HR professional, you know your employees better than anyone at your company. You speak with them daily, so you already have a leg up that most marketers would envy. Ask them about their pain points. Watch their body language. Find out what makes them tick. Then, use that information to craft your messaging, and you’ll likely see your engagement increase trifold.

We’re all human (hopefully). If information is too technical, boring or dense, we tune out. Interactions are more meaningful when they’re engaging. People assume health and benefits will be boring, and when you’re starting with that expectation, it’s even more important to design marketing campaigns that are personalized, engaging and relevant.

Join me on April 19th at HBLC where I’ll be joined by Laura Chambers, Director of Office of Employee Benefits at University of Texas System to present, “Thinking Like a Consumer Marketer at the University of Texas.”