Revolution…

There is a revolution afoot!  This revolution, like many throughout history has begun at the “bottom” and working its way up—up-market! It is a revolution based on the “revelation” that the cost of offering benefits can be different—lower—than what has been “common practice!”  And it is most obvious in the mid-market arena.

Most of this new “uncommon practice” is being conducted by independent, regional, or local advisors breaking away from spreadsheet-bound legacy carriers with misaligned incentives and moving to transparency, accountability, outcomes, and disclosure.  These are not new! However, because of the NSA and CAA, they are becoming central to the discussion these progressive advisors are now having with their clients in the C-Suite. We can thank the Feds for codifying these common-sense practices, but in reality, many of our more progressive consultants, advisors and TPAs have been providing these things all along. There are hundreds of these advisors and advisor organizations  supported by countless point solutions providing data and outcome accountability.

So what is the difference now? I believe that the pressure on employers to reduce costs is so great that they are finally receptive to wholesale change. In addition, there are new products on the market that take advantage of the new “rules,” such as the required removal of “gag clauses” in carrier, network, and provider contracts. Self-funded health plan sponsors and their designated “named fiduciaries” are waking up to the possibility of member lawsuits.  Employers are asking for claim payment reviews and provider contracts that are based on costs--not Chargemaster make-believe--and getting them!

The employer-sponsored benefit landscape is changing faster than l can recall in my 35 years in the Self-funded space and it is very exciting. Plans are saving money, reducing out-of-pocket costs, improving outcomes, and improving benefits by concentrating on transparency, accountability, outcomes, and disclosure—DATA, something the legacy carriers have but are very reluctant to share!

Keep it up, progressive, creative consultants and advisors—we are creating a revolution! DM me if you want to discuss further!