Why brokers should be afraid of Amazon & Co.’s new venture

This article was published on September 5, 2018 on BenefitsPro, written by Kevin Trokey.


Source: BenefitsPro

You don’t have to scroll very far in your social media feeds to see posts of outrage and calls for transparency aimed at the players in today’s health care game. The waste, fraud and at times seemingly criminal behavior of some carriers, pharma and providers is a travesty. All of them need to be called to account for their contributions to this mess.

Oh, it’s happening sweetheart

The Bezos-Buffett-Dimon (BBD) health care venture is heating up. While I have serious doubts about their ability to solve the crisis (I believe that will happen on a much smaller, more local scale), there is one thing that this trio will certainly bring: visibility and outrage.

I predict BBD will open the floodgates of horror stories from victims of the travesty that has befallen our health care system. We will see and hear, at the most publicly visible level, stories we are already sharing within our relatively small inner circles on a daily basis:

  • Lives lost due to inaccessibility of care.
  • Couples who opt for divorce so their child can get the care they need.
  • Artificially inflated insurance premiums that have stifled business growth.

I can feel you getting excited. I can hear you saying, “Bring it on, BBD!”

Be careful what you wish for

The spotlight will be shone into every perceived dark corner of the system, with a particular intensity on anyone seen as a middleman. If you aren’t concerned yet, you should be. Make no mistake: benefits advisors will be next.

I know most of you work your asses off every day with the best interests of your clients in mind. I know the decisions you help your clients make are some of the most complex they face. I get it.

But, perception is reality, and you need to brace yourself for the picture BBD will paint. Be prepared to deal with the perception of being nothing more than a distribution channel for carriers—a middleman.

The carriers are going to be a big target. But when your compensation ties you directly to them, when you are contractually tied to them more closely than you are to your clients, it is going to be very difficult to separate yourself from the carriers.

No time to spare

Now is the time to re-engineer your business to separate yourself from the carriers and to formally serve your clients. I get that there are significant changes you will have to make, many of which are not going to be easy. But there are a couple of things that will take you in that direction.

  1. Sit down with each of your clients and have a stewardship meeting where you explain very clearly the various ways in which you bring them value.
  2. Have a transparent conversation about how much you are being paid for delivering that value. If possible, let them know you will be asking the carriers to remove your commissions and switch to a fee-based arrangement.
  3. Educate them about what is broken about the system and the solutions we are starting to see. Let them know you will be there to help them take advantage of every solution that makes sense.

These may be difficult discussions to have but I promise you, they are nowhere near as difficult as the discussion you will have to have if you wait for BBD to tell the story on your behalf.


Responding to Growing Demand for Transparency

Experts agree that a lack of true price transparency has contributed significantly to the inefficiency in healthcare. Several websites compare the costs for certain procedures at varying hospitals, but it’s still very difficult, if not impossible, to make an informed choice when preparing for a non-emergency procedure. As a result, most people still go to doctors participating in a covered network and follow physician referrals when a specialist is required. In most cases, these choices are made without any knowledge of the cost.

Powerful Mobile Technology

Today, leading TPAs are providing self-funded health plan members with a variety of very powerful mobile transparency tools. One new mobile app enables members to identify fair pricing for more than 200 common procedures, including surgeries, imaging and diagnostic testing. By linking a rewards program, the app awards financial incentives when high quality, competitively priced providers are selected over those with lesser ratings.

Another software maker that describes a third of healthcare procedures as “shoppable”, has introduced a mobile app that enables plan members to search for physicians by procedure, location and price. This tool even goes beyond facts and figures to provide detailed descriptions of the procedure being searched. When members need further assistance, care navigators are available to provide online support via a live chat option.

Expert Administration Still Matters

While a totally open pricing system may never be possible in a business as complex as healthcare, TPAs are making self-funded health plans more transparent all the time. Strategies such as Reference Based Pricing and Concierge Health Advocacy are having a tremendous impact on cost and employee engagement. And while insurance carriers typically withhold claims data from fully insured groups, TPAs are experts at helping their clients put valuable claims data to work to identify cost drivers and manage chronic conditions in ways that help the plan avoid catastrophic claims in the future.

As the transition from volume to value-based healthcare continues, more responsibility will land in the hands of plan members. Smart employers know that a well-designed health plan can foster positive change and lower costs only if members understand their benefits. As long as self-funded plans, highly personal service and creative ideas are allowed to flourish, the number of engaged consumers capable of making economically wise healthcare decisions will continue to grow.


Looney, Fasano want more transparency in hospital costs, cap on facility fees

Article is by Mary E. O’Leary, as seen in the New Haven Register


HARTFORD >> As the legislature looks to rein in medical expenses, state Senate leaders blamed hospital consolidations and the purchase of physician practices for ballooning costs and an increasing threat to physicians who may want to remain independent.

State Senate Pro Tem Martin Looney, D-New Haven, and state Senate Minority Leader Len Fasano, R-North Haven, have tag-teamed on a large number of bills aimed at making costs more transparent to consumers and fairer to lower-cost hospitals.

The pair testified Wednesday before the Public Health Committee where they showed that the Yale New Haven Health System had revenues of $243 million in excess of expenses in 2013, which was 40.7 percent of all hospital profits that year.

The second largest system, Hartford Health System, had excess revenues in 2013, according to data filed with the Office of Health Care Access, of $98.5 million, or 16.5 percent of all profits.

The rest of the state’s 27 hospitals accounted for the remaining 42.7 percent of the $600 million total they had in 2013 to reinvest in their operations.

Looney and Fasano and their staffs have been studying the issue of medical costs for months, starting with a bipartisan roundtable that began holding hearings last year.

They found the share of medical spending attributed to hospital owned physician practices increased by 57 percent between 2007 and 2013.

In the Yale New Haven Health System, the Northeast Medical Group, which is affiliated with Yale, now employees more than 600 physicians and PriMed, which it recently acquired, has 120 physicians in 31 locations.

“My fear is we won’t have any more private physician groups,” Fasano testified.

They found that 60 percent of primary care doctors and 50 percent of surgeons are now employees of hospitals, while the number of cardiologists employed by hospitals tripled between 2007 and 2012.

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