Traditional vs. People-friendly reference-based pricing

By Ray West, Chief Growth Officer


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

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

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

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

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

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

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

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

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

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

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

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

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

Why companies need HR in a seat at the table

By Sheryl Simmons, Chief Human Resources Officer

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

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

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

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

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

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

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

Visit for more details.

Lifting the veil on the healthcare experience

By Rob Butler, Chief Executive Officer


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

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

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

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

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

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

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

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

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

Check out everything else going on at HLTH here.  

Why Brokers Need to Manage Their Clients’ Healthcare Supply Chain

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

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

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

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

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

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

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

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

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

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

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

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

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

The AXA Acquisition: Culture for the Win

By Sheryl Simmons, Chief Human Resources Officer

By now you may have heard the news – Maestro Health™ has been acquired by AXA, the French-based global insurance leader. This is a huge step for Maestro Health in furthering our company’s mission of making employee health and benefits people-friendly again. One of the major factors that ignited this decision was our people and culture.

Having our culture be a driving factor for this acquisition is an incredible compliment to the entire Maestro family. 
One of our in-person meetings with the AXA team took place in our Charlotte office, where it became evident how deep our culture runs. At the end of the second day of meetings, several AXA representatives approached me and asked, “Is it always like this?” They were referring to the way the people at Maestro Health, including the leadership team, interact with each other. We operate with transparency and foster a supportive environment where ideas can be shared and healthy conversations naturally happen, even when we don’t agree. I think they were surprised by how much we genuinely enjoy working together. Not only could they see our core values painted on our walls, but they witnessed Maestronites regularly embodying those values.

AXA has been very open in sharing that after discovering how closely our culture and vision aligned with theirs, they knew they wanted to join forces with us.

They saw us as so much more than an employee health and benefits company – they wanted the opportunity to invest in our human capital.
At Maestro Health, we like to refer to ourselves as “the most experienced startup.” When our company was founded in 2013, our CEO Rob Butler, set out to hire and acquire the most talented and smartest people he could find. This was apparent to AXA as our teams demonstrated their breadth of experience and industry knowledge.

AXA appreciated the fact that our culture doesn’t pigeonhole people into a particular corporate style. Maestronites come from many walks of life and reside all over the U.S., but our baseline is our core values – from there we build on that sameness while we embrace our miles in geography and diversity in our employee base. The AXA team was able to see this for themselves, rather than just hear me and others speak about it. That made a huge impression on them.

Let the fun begin.
I’m thrilled to begin this next chapter with Maestro Health and AXA. I’m extremely proud of the culture and talent our company possesses, and that it led to such a unique acquisition that will transform the U.S. healthcare market. It’s also exciting to imagine the difference Maestro Health can make in the international market to solve the challenges HR teams are experiencing overseas. From where I’m sitting, we’re already ahead of the game.

Click here to learn more about how AXA and Maestro Health are taking a step towards transforming healthcare.

A CHRO's Perspective on #BrokerMinds: Part 1

By Sheryl Simmons, Chief Human Resources Officer

As a CHRO, it’s evident that the shift towards healthcare consumerism has led to a major reshaping of employee health and benefits – and brokers are more valuable than ever. Being on the employer-side of things, I’ve always really valued the role of brokers, but sometimes approach things differently. So I teamed up with our marketing team to commission a third-party study of benefits brokers, consultants and advisors to help all of us step into the mind of today’s brokers to learn about technology adoption preferences. The data uncovered three distinct broker personalities based on their technological mindset – Analog Consultants, Receptive Next Gen Brokers and Automation Leaders.


Chances are you’ve done all the hard work to ensure you have the right broker for your organization and value all they have to offer. In this three-part blog series, I’ll be diving into the data and sharing my perspective on how HR professionals can get the most out of their broker relationship – no matter what type of broker you have. First up, Analog Consultants.

Step into the mind of Analog Consultants.
Analog Consultants tend to take more of a traditional approach to consulting when compared to the other two broker personalities. They have a wealth of experience and pride themselves on the service they provide to their clients. This service-minded approach is likely the reason they tend to have such long-standing relationships with their clients.

While they may be more traditional, they do have an interest in exploring new benefits technology on behalf of their clients – 25 percent stating an interest in learning more about online enrollment tools and 20 percent expressing the same interest in benefits administration tools.

A significant reason for this interest is their concern about staying relevant to their robust book of clients. In fact, 45 percent of Analog Consultants agreed that one of their concerns was staying relevant to the changing needs of technology.

Yet over a third of these consultants aren’t considering Ben Admin tools – meaning some of these same consultants are not adapting to the current industry trends and could be missing key solutions to solve their clients’ needs. The key to all Analog Consultants—no matter where they fall within this data—is identifying their tendencies and communicating your organizations’ needs to them clearly. 

Getting the most out of your relationship.
In my experience, HR professionals who work with an Analog Consultant have a long-vested relationship and rely heavily on them for their legal and compliance knowledge. In fact, 69 percent of Analog Consultants view remaining compliant as one of their clients’ top priorities. However, 69 percent of them also view maximizing benefits offerings as one of their clients’ top challenges.

If this rings true for your organization, then it’s essential to continue engaging in these discussions to ensure your strategy aligns. For instance, if maximizing benefit offerings is a true challenge for your organization, then be sure you are leveraging your broker’s service-minded attitude for assistance. Invite them into the office to host meetings with employees to discuss the benefit offerings available to them and provide the consultation they need. This will help your employees to have the same level of comfort with the benefits your broker is advising as you do.

However, if compliance and benefit offerings are not a top concern for your company, then perhaps it’s time to initiate discussions with your broker to ensure your strategy and goals are aligned. For instance, if HR technology like Ben Admin solutions is of interest to you, be sure you communicate that with your broker. While blue-chip service is a great asset for any broker to have, ensuring you have access to the technology you need to ease administrative burdens and ultimately lower employee health and benefit costs is essential. After all, your broker only knows what is communicated with them.

Take a deeper look into your broker’s mind.
Get the full data on Analog Consultants and other broker personalities by downloading the “2018 Broker Tech Trend Report.”

Stay tuned. Next I’ll be sharing my perspective on the minds of the Receptive Next Gen Brokers.

The AXA Acquisition: Behind the scenes

By Rob Butler, Chief Executive Officer


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.

Inside mLIFE: The Wall of Heroes

Each year, the Maestro Health™ Charlotte office participates in a tradition that has become known as the “Wall of Heroes” and “Wall of Hope” in honor of cancer awareness month. Throughout the month, Maestronites post photos, words of encouragement and stories from cancer survivors and those who have lost loved ones to cancer. Here’s one of those stories from one of our Maestronites, Susan Hobbs:


When asked if I would like to write a few words on why I helped create and participate in the “Wall of Heroes” and “Wall of Hope” I hesitated, as I am not a writer and sometimes struggle to find the words that convey my feelings. But then I was reminded of how important it is for us to tell our stories, because we never know who may have gone through or is currently going through something similar and is struggling or feeling alone. I love telling the story of my little hero, but I will try to keep it short.

 In June of 1990, my life changed forever. While in the hospital after giving birth to my daughter, my husband visited with our four (almost five) year old son Matthew, who wasn't feeling well. Later he told his dad he couldn't hear out of his "telephone" ear (his left ear he used while talking on the phone). The next few days led to a doctor's visit with an ear infection diagnosis, horrible headaches to lethargy, then an MRI a week later that showed Matthew had medulloblastoma. My baby had cancer.

Over the next eleven months, we grieved the loss of the healthy, vibrant life of our little boy but we also celebrated his life and the blessing and miracle that he was and still is to us. We made every second as full of life as we possibly could for him. As a huge basketball-lover, he was able to go to as many Charlotte Hornets games as he felt up to, met his favorite athletes (even Michael Jordan) and never lacked love and support from everyone he met. He was such a warrior.

We are a family of strong faith and I can honestly say that we never gave up hope. Sadly, Matthew lost his fight on June 4th, 1991. This year marked 27 years since I held my baby. But, I will always hold him in my heart and I believe and thank God I will one day see him again.

So, I participate in the “Wall of Heroes” and “Wall of Hope” to help keep Matthew’s memory alive and to help raise awareness and funds for childhood cancer. To be honest, before Matthew was diagnosed, I don't think I gave much thought to childhood cancer. I knew it existed but had no clue how many children were diagnosed each year or the lack of funding there is for research for a cure. Sadly, I now know.

There are so many others, as the wall shows, whose lives have been touched by cancer. Some have happy endings as they celebrate their survivor and their hero. And they continue to hope.

But sadly, others are remembering their loved ones that lost the fight. And we also continue to hope. We all hope for a cure. And we all celebrate our heroes!

I’m grateful that I work for a company like Maestro Health that gives us a place to share our experiences and continues to work to make the healthcare experience easier, especially during difficult times.

Check out the photos posted by our Maestronites on this year’s Wall of Heroes.


Why Maestro Hires Women in Tech

By Sheryl Simmons, Chief Human Resources Officer

The gender gap in the tech world is no secret. It’s been around for a long time and it’s getting worse. In 1991, the rate of women in tech roles peaked at an underwhelming 36 percent and has since been on the decline with women in 2016 only holding 25 percent of tech jobs.

The secret to narrowing the gap.
At Maestro Health™, we don’t have a deliberate diversity program. And yet, we don’t experience the significant gender gap like so many other companies in the tech space. Why? Because we focus on finding and hiring the best talent. Period.  And an amazing percentage of that talent is female. Gender, race, religion, sexual orientation – none of it matters here. If you have rock star-level talent, we want you on our team regardless of what bathroom door you choose.

Show. Don’t tell.
Of course, it’s easy to say you only hire based on talent. Most companies would say they also practice this. However, if you look at who’s sitting around the leadership tables at some of these companies, it’s rare to come across a woman’s face. In fact, only 11 percent of the executive positions at Silicon Valley companies are held by women.

At Maestro Health, we have women in a myriad of leadership positions – and no, it’s not a few token positions. We have women chief officers, presidents, vice presidents, directors, managers, leads – the whole gamut. And not because they’re women. It’s because they’re the best talent for the position.


“Women are viewed as equals and as with every other Maestronite, their leadership skills are highly valued.”  
– Misty-lyn Wogstad
  Vice President of Technology Operations

We are so heavily embedded in a myriad of facets within the tech industry that all employees are encouraged, regardless of gender, to continue growing personally and professionally. If you’re hired for one tech role, but end up having a knack in another area – you’re encouraged to explore that. Again, we don’t care about the package, we care about the person.

At Maestro Health, there's a sense of respect among employees. They've been fully supportive of my career with mentorship, creative work opportunities and recognition. I'm proud to be part of the team.”
Laura Quintero
                                     Software Developer

The fact that a gender gap exists in any industry, let alone an industry that is meant to be innovative, is detrimental. The tech world is desperate for top talent. Strategic business leaders must understand that in order to compete for the top talent of today and tomorrow, gender has to be a non-issue. You must focus on what counts – for us it’s talent, integrity, innovation and character. Picking your talent based on gender is like choosing your coffee based on the mug. Think about it.   

By the way, if you’re reading this and think you’ve got rock star-level talent – we’re always looking for talent.

Check out more of Sheryl's commentary featured in Entrepreneur. 

Where's Maestro?

By Rob Butler, Chief Executive Officer

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

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.”

what makes a company "Cool" anyway?

Chicago Inno Award Logo.png

It’s time we finally install a trophy case. This past month, Maestro Health™ was crowned “Coolest Company” at Chicago Inno’s Chicago Fest – for the second year in a row. But, what does "Coolest Company" really mean anyway? 

Check out what a few of our Chicago Maestronites had to say when we asked them to weigh in:


“Maestro Health is the only company I have ever worked for where I really have the feeling that I am not only part of a team, but my input actually matters. Our leadership treats ALL employees with a level of integrity that is far beyond anything I have ever experienced. It makes going to work PEOPLE-FRIENDLY again.”
– John Pickering, Quality Assurance Lead


“Treats, lunch, lots of cheese … oh, and our executives are very approachable and always available.”
– Christine Buzard, Office Manager


“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



Check out the photos leading up to our crowning moment at Chicago Inno’s Chicago Fest.

Smart Service, Meet Smart Benefit Accounts Technology

By Brandon Wood, President of Client Experience

Our tech can’t survive without our service, and vice versa. So, I felt somewhat uneasy when I saw a particular question come through from an attendee during a recent webinar where we were discussing the ways employees gain financial security with Health Savings Accounts (HSAs). The question posed: “Does Benefit Accounts technology simply automate the employee experience? I’m worried I won’t receive the service I need to support my team and employees.

The truth is technology cannot be truly smart or do its job if the service just isn’t there. In employee benefits, a great “user experience” is much more than the software interface. According to a survey conducted by American Express, 78 percent of consumers have ended a transaction due to bad customer service.

Smart service requires transparency
I’ll admit it, the term “transparency” can come across as just another buzzword. But, transparency is essential when it comes to customer service. Smart companies are well aware of how important it is to their clients. It’s what has proven to make companies like Zappos, who host tours and Q&A sessions in their headquarters, so successful. With 94 percent of consumers expressing loyalty to brands that offer complete transparency it’s clear transparency must be the norm.

While technology that helps employees manage their benefit accounts may not be considered as fun as buying a new pair of kicks from Zappos, the focus on transparency is just as important. One of the best ways to know if your Benefit Accounts solution provider is truly transparent, is to look at their company’s culture. For instance, do they put an emphasis on honesty from the beginning of the relationship – even when it does not reflect well on the individual or team? Have they openly admitted to their weaknesses during the sales process? If so, it may be safe to say that they won’t try to hide any issues from you as they arise. In fact, they will likely identify the problem before you even have a chance to notice and will notify you of the action plan they are already executing to provide a resolution (that is if they haven’t already fixed it).

Smart service includes a partnership approach
Our Client Experience Team feels very passionately about the partnership approach to service. Never wanting to be thought of as just another “vendor,” they approach their work with a partnership mentality and act as an extension to our clients’ HR teams.

Too often vendors have people answering calls who are simply meant to be messengers between the client and the person responsible for fixing the problem. That’s why an Accenture survey found 89 percent of customers report frustration when faced with the need to repeat issues to multiple client service representatives. Our clients’ main point of contact, the Client Relationship Manger, would never answer calls and throw the problem over the fence for someone else to fix. They’re the ones who look directly into the issue and either resolve it themselves or hunt down the answer.

Smart service can predict the future
No, it doesn’t require a crystal ball. However, it does require a sincere focus on the member experience to ensure the best possible engagement with their Benefit Accounts and the least amount of hassle. One solution is to offer members a way to manage their HSA or FSA the same way they manage most things in their life – via their smartphone.

We all know that most people rely heavily on their smartphones. They offer hassle-free ways for us to get information on nearly anything, most of which is via the use of mobile apps. In fact, apps account for 89 percent of the time people spend on their mobile devices. Offering a hassle-free mobile app provides members with a familiar way to manage their account anytime, from anywhere. A smart service mentality will be clear in a mobile app by offering features that allow members to easily upload and submit photos of receipts for reimbursement and simple, clear ways for members to contact someone for support.

Smart service must be a priority
If you’re currently working with a Benefit Accounts provider who doesn’t make service as much of a priority as their tech, it may be time for a change. (me)BENEFIT ACCOUNTS™ is our consumer-driven account solution that makes each account (i.e. HSA, FSA) easy to choose, access and manage year-round. For more information on (me)BENEFIT ACCOUNTS and resources on how to optimize your Benefit Accounts strategy, visit:

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

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 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 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.


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, 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.”


7 Signs You Need to Break Up with Your Benefits Vendor

By Jeff Yaniga, Chief Revenue Officer

Breaking up is hard, especially when it comes to a self-funded benefits vendor. It’s like changing your bank—no one wants to go through the hassle. That’s why you get stuck paying ridiculous fees and dealing with awful customer service. This brings me to my point. Sometimes, we just get so used to things being awful that the pain of a break up doesn’t seem worth it. However, when you finally hit your boiling point, that temporary pain of parting ways is worth it in the long run. If you’re considering a break up with your benefits vendor, below are seven signs why it may be worth the pain. (Sorry, Cupid.)

1. They’re not flexible to your needs.
I’ve seen this happen a lot to clients who are self-funding through large medical TPAs. They’re given rigid plan designs and aren’t willing to work with the unique needs of a company. While this may be the way larger medical TPAs are accustomed to self-funded benefits, this one-size-fits-all approach doesn’t work for most employers today. If you’re in this boat, it may be time to research medical TPA vendors that are flexible enough to personalize their services.

2. Their tech is stuck in the 1980s.
Outdated tech systems seem to be a trend amongst Mom & Pop-style medical TPAs. Their technology lacks depth and isn’t designed with the scalability to meet the needs of larger companies. Luckily, some medical TPAs are upgrading their tech and offering more than just online enrollment like user-friendly mobile apps, data analytics and employee decision support tools.

3. They take all your money.
The cost of employee health and benefits is expected to continue climbing in 2017 – no matter what the future holds for the Affordable Care Act. In fact, it has been predicted that fully-insured companies can expect an 8.2 percent rate increase for 2017. As a result, many companies are calling it quits with their current benefits strategy and moving to a self-funded option as a way to cut costs and increase their plan options.

4. Their idea of customer service breaks your heart.
I can’t tell you how many times I’ve had new clients say to me, “just suck less than the other guys.” Talk about heartbreaking. Of course, they’re referring to their old vendor’s customer service. HR professionals and their employees deserve an empathetic professional to guide them through whatever issue they’re facing. If you do break up with your vendor, don’t accept the same poor service. It’s time to raise your standards – take a look into customer care metrics, like first call resolution rate, and take a look to see if they have their own Client Experience division. Both are signs of a vendor who has their priorities in place.

5. They’re not data smart.
Data analytics are practically a gold mine for HR departments. They can help a business drive down the cost of claims and increase employee engagement. Technology has advanced in self-funding to offer tools available that can flag employees who are exhibiting signs that their health may be at risk, triggering early intervention and eliminating future costly claims.

For example, one of our self-funded clients had a member who was struggling with her diabetes. She was using outdated equipment and her blood sugars were elevated, so one of our Nurse Coaches enrolled her in the Diabetes program, referred her to a dietician and helped her secure new equipment. This helped the employee lose weight and control her diabetes, while also helping the company proactively reduce claims.

6. They don’t seem trustworthy.
I know some HR professionals who have experienced their vendor letting them down so many times that it’s just now an expected occurrence. In fact, they plan for it. They plot out dates when they expect it to happen and strategize how they’ll deal with it. If you’re dealing with this type of vendor-Stockholm syndrome, then you’re long overdue for a break up.

7. They don’t play well with others.
The vendor struggle is real. Managing separate vendors for health plans, benefit accounts and benefits administration can be messy, not to mention put you at risk for errors and gaps in coverage. Modern, all-in platforms can help simplify this nightmare by providing the solutions you need in one easy place for you to manage. You deserve the full package—or at least a vendor who can customize your own HR suite to include all the automated HR functions you want and need. 

As the wise Dr. Phil says, “you teach people how to treat you.” If any of the above scenarios are hitting too close to home, it may be time to kick that vendor to the curb, and research options that better fit your needs.

Join me on February 22nd at 1:00 pm CT, for an Employee Benefit News webinar I will be moderating – Hottest Trend of 2017: The makeover of self-funded benefits.

How to speak (benefits) to any generation

By Sheryl SImmons, Chief Human Resources Officer

I don’t know about you, but it drives me crazy when I read articles that just list the stereotypes of millennials and baby boomers without giving any useful information. Not all millennials are entitled. Not all generation X employees are lazy. Not all baby boomers are out of touch. In fact, they have much more in common than you might expect. There are great people who are born in each of these generations. So it’s time we stop and ask ourselves – are the stereotypes really generational or are they situational?

When I was asked to speak on bridging generational gaps at last week’s Health Benefits Conference & Expo (HBCE), I made it my mission to provide information that people could incorporate into their benefits process that acknowledges unique generational situations. While we did have a lot of fun discussing stereotypes, we all learned a lot about how to use that information to change the way we speak about benefits in regards to each generation’s situation.

How to speak millennial (when it comes to benefits).
During open enrollment, it’s important to take into consideration that this may be the first time many millennials are signing up for benefits. This makes education key, as they’ll likely be unfamiliar with even the most common terminology, and they will be looking for coaching from those who have been in the workforce longer.

An online, consumer-like shopping experience is also a must. Millennials were raised in the age of technology, so naturally they expect to shop for their employee benefits just like they shop for everything else – online. However, it’s not enough to just simply have an online shop for benefits enrollment. They expect it to be intuitive and people-friendly, which benefits shopping has historically been the opposite. If your tech vendor isn’t providing this, it may be time for a change.

To speak like a millennial, one must also think like a millennial. If you’re no longer in your twenties, just think about one of the biggest concerns you had while first entering the workforce – how to get money in the bank. In fact, many millennials are drowning in student loan debt. Here’s a scary fact – the class of 2016 was expected to have the most debt, an average of $37,172. With that in mind, consider a personalized approach to educating millennials about their most financially beneficial options. For example, provide them with information on benefit accounts, like a Health Savings Account, and the advantages they offer when paired with a High Deductible Health Plan.

How to speak generation X (when it comes to benefits).
Unfortunately generation X has become the forgotten generation. While there are approximately 55 million people in generation X, they are overshadowed by millennials and baby boomers in the media. However, this is no reason to leave them out of your benefits communication strategy.

Just like millennials, generation X employees expect an online shopping experience, but they want their benefits experience to come fully loaded with resources. They expect online tools, like cost calculators and blogs to assist them in their research, because they tend to be more self-reliant (their generation coined the term "latch-key kid" after all).

Another trend amongst generation X employees is that they value choices, especially if it provides them with an added feeling of safety. In fact, generation X employees demonstrate more of an interest in voluntary benefits, like vision and even pet insurance, than their millennial and baby boomer counterparts. They’re also just as interested in financial wellness as their millennial counterparts – they’re struggling to eliminate their credit card debt and are losing sleep because they're leaning on their retirement funds for day-to-day living expenses.

How to speak baby boomer (when it comes to benefits).
While baby boomers are getting older (every day 10,000 baby boomers turn 65), that doesn’t mean they’re ready to ease into retirement. In fact, many baby boomers are heading down a second career path. So don’t make the mistake of leaving baby boomers out of your benefits communication strategy.

While it’s typical for people to assume that baby boomers aren’t as tech savvy as younger generations, this doesn’t mean you should completely discount their tech skills. In fact, a third of baby boomers consider themselves heavy internet users. They’re also into their tech gadgets – 33 percent of all tablets are owned by adults over the age of 50. So you can expect them to turn to the web as part of their benefits election decision making process. Baby boomers will arm themselves with information by consuming content, like webinars, videos and blog posts.

Just because you can count on baby boomers to do their homework online, that doesn’t mean you can forgo face-to-face support or printed materials. They still value in-person support and the opportunity to ask questions. If your HR department doesn’t have the bandwidth to provide this type of support, there is still a way for you to offer this employee assistance. Tech vendors that offer a robust, personalized enrollment experience that includes onsite enrollment services is the ideal solution, as it provides support on multiple channels.

Take your (benefits) speak to the next level.
Consider everything above the multi-generational language 101 synopsis. But the conversation (pun intended) doesn’t need to end there. As I mentioned before, I presented on this topic during HBCE last week. I covered the simple ways to take this generation specific info and easily apply for any HR department by “thinking like a marketer.” You can download the full presentation here or tweet me @Maestro_Simmons if you’re looking for more advice on boosting your communication strategy. And for those of you who attended the session at HBCE, be sure to like Maestro Health on the “Bookface.”

ACA Executive Order Issued by President Trump: What this really Means.

by Carol Rito, VP of Product Compliance and Development

On Friday, January 20th, President Trump issued a one-page Executive Order relating to the Affordable Care Act (“ACA”).  The order is basically symbolic.  It is broadly drafted and gives no specifics about which aspects of the law it is targeting and has no immediate effect on employers.

The order directs the Department of Health and Human Services, other departments, and agencies, to exercise all available authority and discretion to waive, defer, grant exemptions from, or delay the implementation of any provision of the ACA that would impose a fiscal burden on any State or a cost, fee, tax, penalty, or regulatory burden on individuals, families, healthcare providers, health insurers, patients, recipients of healthcare services, purchasers of health insurance, or makers of medical devices, products, or medications.  Employers are not among those explicitly listed as requiring protection from regulatory burdens. 

The broad language gives federal agencies latitude to change, delay or waive provision of the law that they deem overly costly, essentially, dismantling of the law even before Congress moves to repeal it.  However, any revisions of regulations already issued through notice-and-comment rulemaking, still requires the agencies to comply with the Administrative Procedures Act (“APA”). 

Under the APA, agencies cannot rescind existing regulations until they engage in a new notice-and-comment rulemaking process, which includes required public comment periods and delayed effective dates.  In other words, it makes it difficult for President Trump to overturn final regulations which have already been implemented.  Only regulations that haven’t taken effect can be suspended, so the President’s chief of staff has instructed federal agencies to cease issuing new regulations and withdraw rules that have been sent to the Office of the Federal Register until they can be reviewed by the new agency heads.

From an individual perspective, while the directive gives HHS wide latitude when granting hardship exemptions from the individual mandate, it does not waive the requirement for individuals to maintain minimum essential coverage. 

From an employer perspective, until further regulatory guidance is released, the final regulations implementing the employer mandate and its reporting requirements remain in effect and are subject to enforcement by the IRS.  In fact, the IRS recently indicated that it intends to begin notifying employers of their potential liability for an employer shared responsibility payment for the 2015 calendar year.  Employers with 50 or more full-time equivalent employees and sponsors of self-insured health plans should continue preparing to comply with the ACA’s Form 1094 and 1095 reporting requirements. 

Now that President Trump has taken initial action on the ACA, it may ease the pressure on Congress to attempt an immediate repeal or find an immediate replacement.

ALERT: Phishing Email Disguised as Official HIPAA OCR Audit Communication

By Jim Martin, Vice President of Security and Compliance

HHS reports a phishing email is being circulated using a mock HHS Department letterhead. The phishing email appears very official, and bears the signature of the Office of Civil Rights (OCR) Director, Jocelyn Samuels.

The attackers are targeting employees of HIPAA-covered entities and their business associates.  Since OCR is the HHS office managing HIPAA audits, these privacy-sensitive professionals are likely to open such an email. 

The email asks the recipient to click a link that claims to provide information about possible inclusion in the “HIPAA Privacy, Security and Breach Rules Audit Program.”  Once clicked, the link directs individuals to a non-government website marketing a specific private sector firm’s cybersecurity services. HHS has not authorized any such use and is taking the unauthorized use of this material by this firm very seriously.

The quality demonstrated in this phishing attack provides an example that others may use, providing an attachment with a link to a virus, a web page with hostile code or simply providing a form for the recipient to complete “for the audit” to provide an attacker more information for social engineering. 

Risk Assessment 
We rate this potential threat as High to Maestro Health™, our employees and partners. This can easily be reduced to a Low risk with prompt education and awareness.  Please share this with your organization and help get the word out to all individuals that may be affected.

What You Should Do:

·      Should you or your organization have a question as to whether you have received an official communication from Maestro Health,. please contact your Maestro Health relationship manager directly.

·      Should you have a question about whether you have received an official communication from HHS, or OCR regarding a HIPAA audit, please contact HHS via email at

·      For more information regarding the HIPAA Privacy, Security and Breach Rules Audit Program please visit:

·      Sign up to receive HHS Privacy and Security alerts directly from HHS, which we highly recommend at