Today’s spotlight is on maximizing healthcare savings through data-driven benefits, which is crucial for any business striving for efficiency and employee satisfaction. We’re joined by Kristen Russel, the visionary behind Fall River Employee Benefits, a firm revolutionizing how Colorado front-range employers approach health benefits. Kristen shares how a blend of competitive analysis, plan design, and cost containment strategies can enhance your benefits program, ensuring compliance while boosting employee satisfaction. Get ready to dive into a conversation that promises to elevate your approach overall with some great information from Kristen. Tune in!

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Kristen Russel – Maximize Healthcare Savings: Optimize Your Plan With Data-Driven Benefits

We have a special guest. The spotlight is on maximizing healthcare savings through data-driven benefits. It’s crucial for any business striving for efficiency and employee satisfaction. We’re joined by Kristen Russel, the visionary behind Fall River Employee Benefits. It’s a firm revolutionizing how Colorado front-range employers approach health benefits.

She has many years of experience underwriting and consulting skills under her belt. We’re fortunate to have Kristen here. She has positioned Fall River at the forefront of benefits optimization, offering innovative strategies and productive and proactive services. Her extensive background in health insurance across the United States has armed her team with insights into negotiating power, not only to secure stellar deals but also to simplify the benefits administration process, which can be a bear overall.

Kristen will share how a blend of competitive analysis, plan design, and cost containment strategies can enhance your benefits program, ensuring compliance while boosting employee satisfaction. Get ready to dive into a conversation that promises to elevate your approach overall with some great information from Kristen. Welcome, it’s good to have you on the show.

Thank you so much. I’m delighted to be back at the People Strategies Forum.

Tell us about how you got into this business overall. What drove you to create Fall River Employee Benefits?

The reason why I started this business was, as you mentioned, that I spent many years on the insurance company side developing products as an actuary, handing out tens of thousands of renewals as an underwriting executive. I saw clear patterns of who gets good renewals, who gets bad renewals, why, and what employers can do about it.

I brought all these strategies to the brokers I worked with and said, “I can help you get a better renewal next year.” Only about 10% or 20% of them were engaged in that conversation. I realized there needed to be more proactive and innovative brokers in the space. I launched the firm in 2005 to do that. We’ve been helping employers demystify this space and get better benefits for less money ever since.

You have a lot to share with us, but my first question for you as we’re getting into this is, what does that mean a data-driven approach to employee benefits? Can you take us down that?

When I go to executives and meet with a CEO, I ask them, “Tell me what your plans are for the company. What are your KPIs? What are your metrics? What are you trying to do as a company?” They lay out a 50-point roadmap of how they’re going to achieve their goals as a company. I ask them about what is their second or third largest expense. It’s their benefits. I ask, “What’s your roadmap and your metrics for that?” They’re like, “I don’t know. I hope the insurance company doesn’t give us such a terrible renewal this year.” They’ve got nothing. They don’t have a game plan.

What we help our clients do is to create a sustainable 3- to 5-year game plan of knowing where you stack up to the competition, what you need to do to get where you want to go, and have some metrics and plans of how you’re going to get there. Benefits are not a lot of HR people’s favorite topics. It’s numbers-oriented, and not everyone who’s great with people also loves numbers. We are trying to help people run their health plans the way they run their businesses because if you run your business the way you run your health plan, you’d be out of business.

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Competitive Benefits

What is the first step when you’re looking at conducting a competitive benefits study to ensure that they’re competitive in your developing this three-year plan? How do you go about doing this?

You have to have great data at your fingertips. No employer can have enough data to do a competitive analysis on their own. They have to be part of a great benchmark survey. We provide that as an opportunity. That’s something that we’ll get into as we get into the material. There are a lot of tools out there.

 

I’m excited to share with you some strategies for how you can get more data-driven around your benefits and be able to use some strategies to lower healthcare costs. This has been my passion. For many years, I’ve been in this industry. I did start when I was four. I have been seeing the patterns for many years. If there are certain things that we consistently do, you are going to see lower renewals over time. I’d love to talk through that.

We’re going to cover four different things that are important to help you not only be more data-driven but also lower those costs over time. The first is to get that competitive data, benchmark it, and understand what it looks like. I’ll show you an example of what that data could look like, but there are multiple ways to get that.

Secondly, we think that it’s important that companies need to modernize their plan designs. Plan designs looked different from the introduction of high-deductible health plans. In 2003 and 2004, plan designs looked the same in general since the early ‘90s when copay-style plans first came out. When companies modernize their plans, they can do much better. They can get better value out of their plans. We’ll talk about repurposing the money you’re already spending on healthcare in a more modern way and what that can look like for savings.

The next thing that is new, and honestly wouldn’t have even been possible several years ago, is that the research is proving clearly that the holy grail in healthcare is getting your employees to see the highest quality doctors. It may seem counterintuitive, but the highest quality doctors cost the least in the long run. It’s like buying a reliable car that will pay off in lower maintenance costs. Getting a great doctor saves the plan money.

 

Until recent years, there was no reliable way to determine who those top doctors were, and now there is. We are encouraging people to seek quality first in healthcare. We’ve designed an entire plan around that. There are other ways out there. We think the quality first plan is one of the better ways to get after it, but as long as you’re doing something to drive your employees to better quality of care, you are on the right track.

Finally, if we have time, we will get into some common mistakes that employers make regarding their wellness plan designs and how they can flip those around and use best practices to help their employees get healthy. We know that the best way to sustainably get better renewals every year is to become a better risk. There are no magic purchasing solutions. We have to use better quality healthcare and help employees get healthier. Those are the fundamental problems. That’s what we’re going to dive into. If you’re ready, I’ll start digging in.

Let’s do that.

The part of the reason why this is important are two reasons. One, healthcare is the second or third largest expense on every employer’s P&L. It is going up at a pace higher than anything else that you buy as an employer. The second reason why this is critical is because if you don’t get your benefits right, you’re not gonna win talent in this environment.

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COVID changed everything. We are in a competitive environment. This graph says that 70% of talented HR professionals agree it’s bad. Even though some of this is a bit dated, it is still the case that we can’t afford to make mistakes. We’ve come across companies that get their job offer accepted, but it’s rescinded once they see the health insurance, and we can’t afford that.

Know that the first question I get almost every time I do a presentation is everybody wants to know, can I get the slides for this presentation? Can I see the materials? Those of you reading might want to see all of this. You can email me. We’ll make that available to you. That is [email protected]. If you email me with your company name and best phone number, I’ll make sure that you get these slides. We’ll also do a prize drawing for anyone who requests those slides before April 19th, 2024. We would love to enter you into our Amazon gift card drawing.

You read my personal background. The company background is that we have seen over the years that employers have been frustrated with their healthcare costs. We wanted to create strategies to help them fight back. We help people get better benefits for less money, become employers of choice, and be heroes to their employees. We want you to avoid losing candidates to competitors and having job offers rescinded.

We are part of a large organization called the Alera Group, which has 4,000 employees across the world. We’ve got the ability to serve people nationwide. Our headquarters is in Denver, Colorado. Why are we talking about benefits when HR folks and talent managers have many things they’re thinking about? For one, benefits tie people closely to you as a company because they connote emotional security.

When you, as an employer, make investments in mental health, which is an important part of your benefits package that pays for itself in terms of productivity. This is the single most important place for employers to start and make sure their benefits are right in the mental health area. The obvious reason that’s been around for a long time is benefits are more efficient than salary raises because most benefits are tax-free.

 

Why is this such a hard area in the first place? We have many headwinds in the healthcare world of why healthcare costs have been spiking in recent years. Some of that is due to COVID, catch-up care, and delayed care. People aren’t getting their cancer screenings. They’re presenting with stage three instead of stage one. There are lots of things that have happened related to COVID. We also have long COVID issues. We have increased mental health and substance abuse issues since the pandemic.

The healthcare industry itself has things that are not related to COVID. There are all these new gene therapies, cellular therapies, and specialty medications. Many of you are starting to see a spike in your claims due to the GLP-1 class of weight loss medications. They can be effective, but they are expensive. Broad inflation is now under control. In recent years, all that inflation that hit is now starting to show up in healthcare and hospital contracts. Both insurance companies, hospitals, and doctors’ offices are seeing wage inflation like we all are.

There’s a lot going on there in terms of headwinds. What can you do about it? We have some specific suggestions at a high level, and we’ll get into four strategies. You have to run your health plan like you run your business with a game plan, metrics, and things you’re working towards. You need executive endorsement. You don’t run a company without the attention of the executive. Why are you running your second or third largest expense without the attention of the executives?

For recruiting purposes these days, you need to have at least one medical plan that is either free to a single employee or low cost. That’s something that not everybody’s able to do, but some of these strategies will help you get there. We think that count-based plans are important. We teach people how to buy less insurance, put more money into account-based plans, and make employees better off as a result. It’s important to incent members to use the highest quality care and seek quality first. You need to have comprehensive communications so that the employees know about all these great things you’re doing.

Data-Driven Strategies

Let’s dive into these four strategies. I’ll give them to you at a high level, and we’ll dive into each one. First, you have to benchmark your benefits. We want you to know where you stack up versus your competition. We’ve had clients come to us in the past and say, “We think our benefit package isn’t good. We think we need to lower the deductible or whatever it is that they think the solution is.” When we put them up against the competitive data, the deductible isn’t the problem at all. The problem is the premium that’s coming out of the employee’s paycheck. You want to solve the right problem. Unless you look at the data, you don’t know what the right problem is.

Secondly, we talked about buying less insurance using account-based plans. We are going to show you how you can repurpose the money you already spend to get better benefits. Third, we want you to incent members to seek quality first when changing doctors. We’ve designed a whole healthcare plan around this, but you can do that in multiple ways.

Know that making sure your employees stay in a network is a necessary first step, but it is not sufficient. You’ve got to help them get one step further. What happens is that doctors are not following evidence-based medicine, making more misdiagnoses. They have more complications, infections, and problems. I’ll tell you a little story about why this is so personal to me. Finally, if you can eliminate some of the most common wellness plan mistakes, you can turn that from an expense in your company to a serious ROI-generating investment you make in your people. It’s also great for your culture. We want to do it right.

I’m going to dive into what a benchmark could look like. I’ll give you a sampling of it, but I want to give you a taste of what some of the data should look like. In the meantime, Char, Sam, and Howard, what are some of the things that I mentioned that you would emphasize and say, “Yeah, that’s particularly important for the typical HR or talent team?”

Go ahead, Char.

As an employer and a business owner myself, it was a real challenge to ensure that we had good benefits for our employees. I agree that it was costly. We wanted to attract and retain the best talent. We did have some candidates who rescinded their acceptance of the job because, at times, we did not have the correct benefits that would meet their needs.

We had unique medical circumstances with some of our employees. One of our employees was under the age of 26 and was about to turn 26, but she had an MS or some special medical circumstance that required some specific expensive medications. I used my health advocate to coordinate the benefits with her benefits and her parents’ benefits. It was a complex problem. However, when we were able to work through some of those challenges and support her, she became one of our highly productive, happy, enthusiastic employees, even with all her disabilities.

She appreciated that we had the compassion, dignity, and respect to take care of her and her benefits. If our benefits did not meet our needs, we tried to enhance our benefits or at least find her the resources to help with her benefit coordination. I feel, as a smaller company, I was able to do that with more agility. When I was working with 160,000-plus organizations, we became the 1-800 number. I heard a lot of employees say, “I don’t feel there’s a human on the other side of the phone line. I keep going call trees, and I’m not getting any help.” I was partially answering your question, but what are your thoughts? Is Fall River catering more than a humanistic approach to support the employer and the employee?

We certainly do. If you have 160,000 employees, you would need an internal team to help with that thing. We try to serve as an extension of the HR team of the clients we work with. Members can call us with all of their tricky healthcare situations. We can certainly come back to that further, but I want to get you into some of this data.

This is a nationwide survey. This benchmarking survey is designed to help you understand how you stack up to your other companies in your geography, industry, and company size. One of our goals is to help you understand what your recruiting superpower is. If there’s something great about your healthcare plan, we want to identify it for you and help. People don’t always know what the best aspect of their benefits is. We will help you identify what your superpower is. We want you to put that in all of your job ads, not in the fine print, not after they interview or accept, but right up front. Tell people about this.

Where you aren’t as competitive, those are the areas or places where you want. We’ll give you the proof that your benefits rock and you can shout that from the mountaintop to your employees, or we’re going to give you a proof to your leadership team that you’ve got some holes you need to fill, and here’s the data that you need to prove it to them because it’s their natural bent to say, We got a lot of competition for these resources.” Everybody complains about benefits. They’re expensive, but this can give you the actual proof.

Let’s look at one example of what some of that data might look like. You might be getting benchmarks on. We start with some general information when we benchmark how many hours you get benefits at 24 and 30 hours. What’s the threshold? Do you offer domestic partners? How long is the waiting period? Are you competitive on that? What benefits do you even offer?

Everybody that is in our survey offers medical or they wouldn’t be in the survey. We start with, what are the other benefits you offer? How many offer dental in your industry? How many offer all these various coverages, vision, life, disability, accident, critical illness, and pet insurance that employees might need to help them manage their lives?

Once we have that overview, we’ll start digging into the medical plans. This is an example of a company that we’re seeing that offers three healthcare plans, which is not as common in their industry, which is peer group one. Most organizations in the public sector only offer a single plan, which is surprising to some in the private industry. This company was offering free plans.

You can get a feel for where you stack up in all kinds of aspects. How is that funded? Are you fully insured or self-funded? Does that vary by industry? To what extent are you using copay style plans, which is the 1990s style design, versus are you using high deductible health plans or account-based plans? You can get a feel for what type of networks your competitors are using. Are they providing monetary incentives to opt out or other things? Once we go through those large overview types of things, we can dive into your plan design.

Here’s an example of how we want to compare copay plans to copay plans and high deductible plans to high deductible plans. First, look at what we might look at in a benchmark for copay-style plans. You want the ability not only to identify the median in your industry or your state. We think it’s important for employers to understand what it would take to be an employer of choice and be at that 75th or even 90th percentile of great benefits of the top 10%. What do you have to do to get there?

A good benchmark can show you that. It might show you how you stack up to your higher deductibles stack, your out-of-pocket maximums, how many deductibles a family has to meet, and what your co-insurances are. All of this can be useful, and it’s interesting to see how things vary by industry versus geography versus company size.

You can drill it down to your specific industry.

We drill down one dimension at a time. For example, in this one, anytime you see a green bar, that shows what the public sector is doing because this happens to be a public sector organization. Separately, when we look at peer group two, we’re looking at this company that is headquartered in Colorado. We’re looking at all Colorado companies.

Depending on the industry and whether or not we have enough data, we can look at those at the same time. We could look at only public sector entities in the State of Colorado. Some intersections of that will have enough data to be credible, and some will not. You can start to drill down and at least get directional feedback.

Kristen, how many participants do you have in this particular database?

We’ve got about 13,000 plans, which is under about 6,000 employers. That was the number in 2023. We’re growing every year. We are hoping to have this grow. I would invite anybody. If you have 50 or more employees, we will do a custom benchmark for you. If you aren’t quite that large yet, we can provide you with an industry benchmark.

This is something that you can reach out to us. [email protected] is the easiest way to do that, or you can go to FallRiverBenefits.com and request a quick connection. We can talk for five minutes, and I can get you everything, find out your info, and get you everything you need. This is the information that we think is useful. If we were doing a full-on client benchmark, we would go into what your high deductible health plans look like, what your Maridental disability plans are, and how competitive they are.

There are other benchmark surveys out there. Most of them are heavy in Fortune 500 companies. If you are one, that is the benchmark you want. Ours is a mid-market benchmark. Most of the data is in the 50 to 5,000 employees space. That’s more attuned to where most businesses live. Fortune 500, by definition, there are only 500 of them. There are tens of thousands of small businesses.

This is important work. What I do as a compensation specialist is that we often use benefit studies like this in partners like you to help determine the competitiveness of benefits. We know how aggressive we need to be on the compensation side.

Any comp study without a benefit benchmark would be somewhat incomplete.

 

You have to look at the total rewards.

This is strategy one. You have to know where you stand and where you stack up so that you can make a game plan. Once you have that in place, we want to help you get better benefits for less money. We’ll talk about two different strategies within that idea of getting better benefits for less money. The first is to repurpose the money you’re already spending on benefits. We’ll talk separately about incenting employees to seek quality first when they choose their doctors.

Let’s dig into what this looks like. When you’re thinking about your healthcare dollars, employers need savings and there’s always competition for care. What we see is that companies almost always get in this tug of war with their money between the finance people. They’re like, “We have to meet the budget.” The HR people might be like, “We have to attract people.” It’s this tug of war. Our goal is to free up a pot of money. You can decide together how you want to spend it. We can do that because the distribution of healthcare claims is not equal. The way copay-style plans are designed, they’re acting as if everybody needs the same healthcare, but they don’t.

Most people use $3,000 of care or less in a given year. The typical designs do not take advantage of that fact. What we’re seeing is that with account-based plans, if you can take the copay plan that you have and restructure it on a high-deductible health plan chassis, you don’t have to pair it with HSA. You can pair it with an HRA, which gives you a lot of flexibility.

You take some of the savings from eliminating the super-rich copay elements, which insulate people from the true cost of care and sometimes prevent them from making smart decisions. Instead, you take some of the savings and use it to give employees a pot of money they can spend as if they were their own to make better decisions with their healthcare.

When you do that, there’s almost always leftover savings. In our analysis, after we change the plan style and make sure that employees are at least as well off as they were before, we still see $1,400 per employee per year on average leftover. For a 100-employee company, that’s $140,000. You can use that to make your employee’s benefits better, or if you need to, you can drop it to the bottom line. Regardless, this has been a very successful strategy.

When you repurpose the dollars you’re already spending, you can do it in several ways. This is something that your current broker can do for you, and we encourage you to ask them to say, “I heard on a podcast that if I get rid of my copay plans and use more modern designs, I can save a lot of money. Can you model that for me?” Any broker worth or so should be able to do that for you.

The way we look at it, and this is a model you could ask your broker to follow, is first, we look at your existing plans. We score how valuable they are by calculating something called the actuarial value of a plan. That’s a metric that says how good this healthcare plan is. It doesn’t talk about what they take out of their paycheck. It speaks to the richness of the plans. Once we know that, we know we can’t go below that because we will never reduce employees’ benefits. I’m morally opposed to it.

We’ll look at two different scenarios. One is to identify the pot of money that you can free up and get the best possible savings. There are situations where companies are debating. They’re either going to have to cut their benefits or do layoffs. What we can do with this strategy is help them avoid either one because we’re going to free up some savings in this. If you’re in that financial position and you have to drop them to the bottom line, that’s great.

What we’re seeing a lot of companies do, especially in recent years with the talent war fierce, is that they are instead directing those savings to help people get better benefits. Sometimes, they do it in the form of the benefit plan itself, making the out-of-pocket and the deductible lower, but a lot of the time, we’re focusing on helping them create a lower contribution. Employees can get that plan with less coming out of their paycheck. That’s what is most in demand now.

Those are two things that can be modeled out. Let me give you an example of what this looks like. For those of you who have seen these slides, we’re seeing three different lines on this graph. The red line represents the upward trajectory of healthcare costs if you do nothing. This is the status quo. In this particular example, we have a company that was spending about $1.2 million on healthcare. Several years later, they’re going to be spending almost $1.9 million every year.

We showed them two different scenarios. We always start by showing them a way to save money. That’s on the yellow line where you can see that we can immediately save them some significant amount of money, going from $1.3 million down to $1 million. These plans also trend better because of the account-based elements.

One of the advantages of buying less insurance and putting more money into employee accounts is that you don’t pay healthcare trends on things that aren’t health insurance. That can be helpful. This was saying that with the savings, we’re going to immediately drop about $350,000 to the bottom line, and you’re going to trend better. We’re showing a five-year projected savings of $2.5 million. There are some companies that need to have that to drop to the bottom line.

For companies that can afford it, we can take some of those savings and plow them back into having a better employee experience. The third line on this graph, which is shown in blue, is the trajectory. If we spend about the same money now but do it more efficiently using account-based plans, that enables our cost and allows us to put money back into the hands of the employees. Even though we spend all of the savings in the first year, you’ll see that the red line and the blue line match in year one, we are still going to trend better and the employer is still dramatically better off several years down the road, even though they gave the employees a much better benefit.

The first strategy saved $350,000. The second strategy didn’t save anything in year one, but over several years, it still saved $800,000 for the company. Meanwhile, employees got dramatically reduced contributions as a result of this strategy. Things were different. They no longer have a $10 copay for an office visit, but in certain circumstances, using an HRA, they have an account of money that they can use to pay for all their healthcare needs. Almost 80% of us won’t need more than $3,000. They can use the difference, and they can add that up over the years. Their benefit can grow richer every year, which is a great retention incentive. This offers a lot of powerful results from employers who are willing to undertake it.

It’s great to see that there are different strategies or levers that an employer can use to achieve these substantial cost savings. What is the best size of an organization to start thinking about such a program like this?

I’m not sure there’s a size where this isn’t a helpful strategy. If you are spending hundreds of millions of dollars on healthcare, even if you did a small amount of this, the savings would be staggering. In terms of total dollars, that would be a big difference, even the smallest of employers. I’ve helped companies with ten employees convert their copay style plan into something more modern where they’re using account-based plans. One of those companies was able to keep their healthcare costs from where we started. We had a big drop. Even though they had small increases over the years, they kept their healthcare costs flat for several years by using this one strategy. That’s a big deal for a small business because they don’t have a spare dime to waste.

Are smaller companies often at a disadvantage when trying to provide?

Smaller companies do have fewer levers that they can pull to manage their healthcare costs. If you are under 50 employees in the small group market in your State in Colorado, we go up to 100 for the small group market, you don’t have a lot of levers you can pull. Your rates are based on the age of your employees and the plan design you select. That’s why this plan design becomes powerful. If you are self-funded or even level-funded, which is the first baby step into self-funding, you can get a few more levers to pull, but plan design is the best friend for a small employer. Using these account-based plans is important.

Thank you.

Quality First Strategy

That’s a strategy that anybody can use. We can pair this with the next strategy, which is the quality first strategy. In order to understand why this next strategy is powerful, we have to understand what is broken about our healthcare system. We alluded to this earlier. The top providers, which are those that practice evidence-based medicine, get the best results, but the doctors who don’t induce significant costs onto the system, unnecessary testing, complications, infections, recovery time, inappropriate risk, and prescribing patterns.

There didn’t use to be a lot of data out there, but in recent years, all of this transparency in healthcare laws that required everyone to put a machine-readable file on their website and all of these types of things that employers had to do seemed like a pain in the butt compliance type stuff. What it has enabled is massive data sets that, if you have a partnership with a great technology company like we do, can translate into some easy-to-use data on how to find the best doctors who are practicing evidence-based medicine.

I’ll tell you why this is personal to me. My grandfather was an incredible scholar. All his life, he had a heart murmur, but he wasn’t healthy enough to get it fixed. Later in his life, he got his act together health-wise and was healthy enough to get it fixed, which was going to give him a lot more energy. He checked into the hospital, and unfortunately, he never came home. He got a hospital-acquired infection, which was due to bad protocols and bad wound management from the doctor and the hospital. It was completely unnecessary, and he died.

We don’t want that to happen to anyone that we love. The best gift I could give to anyone is the ability to find the best doctors. I’m in a fortunate position because I now have that ability. When most of us need a new doctor, what do we do to find a doctor? Sam, last time you got diagnosed with something new or had an injury, how’d you find a doctor?

It’s a matter of asking around your friends and family. What is the best way?

We think the best way, because we’re all about being data-driven, is to rely on the data. Most of the things on this page are not entirely reliable. I once had a good doctor, but I fired her because she told me that I had to stop eating sugar, stop burning the candle at both ends, stop being a dope, and need to lose weight. I did what any self-respecting American would do. I fired her. I didn’t know anything about health, and she hurt my feelings. Looking back, she had the guts to tell me the truth. She was a great doctor, but I didn’t go with that.

This is unreliable. We know that Google reviews are unreliable for doctors because they’re influenced by drug seekers. If the doctor gave you the drugs you wanted, you’re going to give them a five-star, and maybe they shouldn’t have. We know that in-network status is not enough. We said it’s necessary but not sufficient to be in-network because when an insurance company contracts with a hospital, the hospital requires it every time. You have to take every single doctor under our roof. You can’t exclude any. You’re getting the best doctors in that hospital, but you’re also getting the worst. That’s what a network is made up.

We have to help people find better providers. There are navigation programs like Alight and Caslight. The problem is most of them achieve 3% to 5% utilization, and they’re not making a dent in getting people to use top doctors. If you’re a Fortune 500 company and you get 5% of your people to use a navigation program and find a better doctor, it’s worth it. It paid for itself ten times over, but it’s not making a dent in the average employer. How do we get people to use top doctors? You have to have an incentive, and it has to be meaningful.

We’ve designed a healthcare plan around this, but there are other ways to approach it. We want to make sure you’re doing something to look at quality in healthcare. We think the most important thing is to have technology that enables you to identify the top providers and lay this on top of your existing healthcare plan. There have been plans out there for multiple years. There still are. United Healthcare and Aetna have one where you can base your plan design on the quality of doctors, but there are several problems.

One, insurance companies don’t have data because they’re not allowed to have each other’s data. You need a third-party technology that can gather all the data. Secondly, if a change in insurance company is required, it’s not going to happen because employers have a lot on their plates, and it’s hard to change carriers. You don’t want to do that often to your employees.

What you need is something that you can lay on your existing plan design. That will give an incentive if people use top doctors, and it won’t give an incentive if they don’t use quality first doctors. The partner that we work with has a mobile app. You can also use a concierge, but you get the incentive by using technology.

One of the things that we learned in the research with our technology partner, and they have 310 million people’s worth of claims for several years, is that the thing that matters most is the individual physician that you use. It doesn’t matter what hospital you go to. This is an example from the Denver Metro area of three hospitals. There are star ratings saying they’re a great hospital for cardiology.

 

These are some of the top three. St. Joseph’s shows up the best. If you looked at the star ratings, you’d say, “If I have a heart issue, I need to go to St. Jo’s, and I should stay away from Denver Health. When you look at the details, and for those reading, we’ve got some detail on the graphs that show the individual doctor scores. It’s quite different. It’s not that St. Jo is all the best, and Denver Health is all the worst. It’s that there are quality doctors, which you want the highest quality doctors, and it doesn’t matter what hospital they’re at. That’s what we’re trying to get towards.

It’s important to get that because using a top doctor versus an average doctor saves 27% per episode of care. That means, as an employer, if you’re a CFO reading, if you save 27% on a big chunk of your healthcare, there’s a lot of money left over for incentives, and it still saves money as an employer. Best doctors get people back to work faster. They have fewer sick days after surgery. Sam, you sounded like you wanted to ask a question.

The best doctors get people back to work faster. Share on X

There’s a lot of good information there. It’s important to think about quality care. I was about to say, “Good quality care gets people back on their feet faster and helps productivity and happiness.”

I had a friend who had seen 2 or 3 dozen doctors over the past several years to figure out why, despite a healthy lifestyle, she could barely get out of bed in the morning. I helped her use this technology to find some of the best doctors in town for those types of issues. She was in a doctor within about two weeks because our technology also identifies doctors who can see you, which is helpful for members.

Within that, she got on the right. It turns out her body didn’t know how to use the food she was eating. She was starving to death. Once she got on the right enzymes, because the doctor identified it right away, within a couple of weeks, she was already starting to feel better. Now, she’s on a path to a full recovery, but she had been trying for several years to figure out what the hell was wrong with her. She even had to take FMLA leave to call doctors all day. Now, she’s on the mend. That’s the power of this. Talk about productivity lost by that company because they didn’t have this technology.

The incentive is what’s key. We design plans. If your members use the highest quality care available to them, they will get the first $3,000 to $5,000 of their healthcare paid for free. For those of you who are reading carefully, remember that 80% of people use less than $3,000. If you are giving people the first 3000 of their healthcare free, that means those who are willing to seek out and use the highest quality doctors first will never have to pay a dime for healthcare in a typical year.

This is what’s powerful. It would be helpful if members could get this information easily on an app. The one that we use helps people drill down not only who the best doctors are but also, if you do it like this, the first graphic shows a mobile phone with the top fifteen doctors and their scores. The top doctors will be in the high 80s or 90s. It shows why they got that score. It verifies that it accepts your insurance and they have appointment availability. It indicates why that doctor has such a high rating, whether it’s their diagnostic skills or the treatment prescribing. Once you find those top doctors, anything they order is covered by this quality first incentive. You can get almost everything paid for.

I have one slide on here, which is a little thick and shows some math. I won’t go through all of it, but what it shows is that one sample employer that we modeled this for. This was a smaller company. It’s about 42 employees enrolled. They were spending about $10,000 an employee and $420,000 on healthcare.

We showed them two different strategies. One was a status quo but better plus strategy where we were going to take their actuarial value, which is the richness of the plan from 79% up to 85%, where members would get the same benefit if they didn’t use a quality first doctor. If they did use a quality first doctor, they would get the first $1,000 of their healthcare free. That saved a little bit of money. We used the savings on it. That made the benefits better.

Another strategy was to double down and use a more aggressive design, pairing it with some of the account-based strategies from the last section, which enabled them to save 8% on their costs while also raising the value of the benefits. This was a small company. We’re seeing about $32,000 of savings. It’s not a big number for those of you who run big companies out there, but 8% of healthcare, saving that much while making the benefits significantly richer, that’s hard to do in the absence of some creative strategies. Even if you want to save 8% without making the benefits richer, you have to induce a fair amount of pain on your employees. If you’re trying to save 8% through deductibles and copays, it’s hard to do. This is a better way.

A reminder that you can get all of the content for this program if you send an email to [email protected] with your company name and best phone number. If you do that before April 19th, 2024, you’ll also be in our Amazon gift card drawing. Sam, if we have time, I’ve got some information about wellness, but this can be a bonus program for those who get the slides. How do you want to proceed?

We do have a few more minutes. If we can pack it into a couple of minutes, that’d be great.

Wellness Program Mistakes

There are some common mistakes that employers make when they’re designing their wellness programs, or they’re scattershot effort. There wasn’t a design to begin with. The first biggest mistake is that leadership is indifferent or they’re not involved at all. Another example is your leadership team is not setting a good example. They’re some of the worst offenders in terms of unhealthy lifestyles. They’re contradicting the messaging, or they’re not trying. We don’t need everyone to be a triathlete on the leadership team to have a successful wellness program, but we need them to come along with us and at least try to make some changes.

We don't need everyone to be a triathlete on the leadership team to have a successful wellness program, but we need them to come along with us and at least try to make some changes. Share on X

Another mistake that’s common because a lot of wellness resources come from your insurance company is if it’s only available to the people who are enrolled in your Cigna, United, or whoever health plan, that’s not going to be as effective as at creating culture change as if everybody can receive a a strong incentive.

The biggest area that I think is the most common is that incentives are misdesigned. They might have something like a $10 gift card or free lunch for anyone who comes to the wellness seminar at lunch. You’re going to attract marathon runners who want to improve their time and people who are already nerding out about this. You’re not gonna get a cross-section of the population because you don’t have your incentives designed right. It does not cost you a dime to design an incentive that will dramatically motivate your population.

You have to have a strong education component. If people don’t know how to get healthy, it’s hard to motivate them to do it. You need some fundamental education. This is the theory of everything. This is the foundation of it. Most people don’t track any metrics that are going to help them calculate an ROI. It’s no wonder that executives give up on the program because they don’t think it’s resulting in any improvement.

Here’s what we suggest that you do instead. You need to include all your executives and managers, and you need to say to them, “We want to do a powerful wellness program.” This ideally comes from the CEO. We want to do a powerful wellness program, and we need everyone to either practice these healthy habits or, if you don’t have these habits yet, start to make small changes so that the employees can see and share your journey.

We don’t want the program to contradict itself. If you’re telling people all these great nutrition tips, but then the building is filled with soda and candy machines, and at every luncheon, you bring in pizza, you are contradicting yourself. You need to show people what healthy alternatives look like. You need everyone included, even if they’re not on the health insurance. Find another way to get them an incentive.

We think the most effective incentive is not gift cards or those types of little things. We have wellness rates for our health insurance and non-wellness rates. If you want the wellness rates, there’s a list of things you need to do. In the first year, it could be as simple as showing up to a seminar or taking a health risk assessment. Over time, that list needs to grow. It will drive every aspect of your wellness program. That doesn’t have to cost you a dime, but you raise the rates for people who are not willing to be part of the solution.

You have to have some fundamental education. Our company put on a great internal nutrition seminar. I nerd out about that stuff. I knew most of the stuff in this seminar, but for some people, it was a revelation. They’re like, “I had no idea that I should be watching my sugary content. We know it in theory, but we didn’t know how to do it.”

All of that education is important. You have to review it to determine ROI. Not only can you keep the support for it, but you also determine what’s working and what’s not. You can improve it every year. Remember, you want to run your health plan the way you run your business. If your business never took stock of what’s working and what isn’t working, you would not likely be successful. You have to do the same thing with your wellness program and with your healthcare benefits. Run your health plan like you run your business, and you’re going to be a lot more successful around this. I’m happy to take questions from our distinguished panel here, and I would love to hear your thoughts.

This is packed with tons of information there, Kristen. Thank you so much for sharing your time with us. This is great.

I have learned a lot.

It’s fantastic information. Awareness and education are keys. It’s a nice presentation. Well done. Thank you so much.

You’re so welcome.

Thank you, everyone, for reading. We’ll see you next episode. Take care.

 

Important Links

• Fall River Employee Benefits
• Alera Group
• [email protected]

 

About Kristen Russel

Kristen Russel is the visionary founder of Fall River Employee Benefits, a company dedicated to helping Colorado Front Range employers optimize their employee benefits programs. With over fifteen years of experience as an actuary, underwriting executive, and consultant for health insurers nationwide, Kristen has a deep understanding of the intricacies of carrier rate setting and renewals. This expertise provides her with a significant edge in negotiations, enabling her to secure the best possible deals for her clients.

At Fall River, Kristen and her team leverage their insider knowledge to simplify benefits administration and ensure employers receive the most cost-effective and suitable plans for their needs. They specialize in serving businesses with 25 to 500 employees, providing a crucial second set of eyes on health plans. This includes evaluating how benefits compare to other employers, ensuring the design fits the employee population, maximizing cost-containment strategies, and ensuring compliance with ERISA, Section 125, HIPAA, and the Affordable Care Act to avoid fines or penalties.

Kristen is passionate about using her skills to contribute to employee attraction and retention, helping employers make informed decisions about their benefit dollars. For more information on Fall River’s services and to view their no-cost, no-obligation evaluation process, visit Fall River Benefits or check out their informational video on YouTube.