Where do brokers fit in the health care continuum?

Alan Goforth | March 05, 2018 | BenefitsPro

Technology, market forces and regulations are expanding the healthcare continuum at an ever-accelerating pace. Brokers have their hands full simply processing and understanding the rapid changes, let alone showing clients how to integrate new concepts into a comprehensive benefits package.

Now is a good time to ask the question that’s on everyone’s mind: Will brokers take on a more critical role in this brave new world, or do they risk falling by the wayside? The short answer is, “it depends.”
“As solutions become more sophisticated, companies that are buying those solutions need advisors to sift through them,” says Prashant Srivastava, PhD, cofounder and CEO of Evive in Chicago, which provides customized health care recommendations. “Brokers who have been strategic consultants in the past will remain relevant; however, traditional brokers who simply took a piece of the action on insurance purchases may find themselves disintermediated.”

The challenge for brokers is to understand how the care continuum is changing and how to make themselves an indispensable resource as clients react to those changes. First, it helps to know what is causing such rapid change.

Driving forces

The healthcare and benefits industries have always evolved and expanded, but rarely at their current speed. Srivastava points to three factors that are driving these changes.

“The obvious factor is cost,” he says. “As a system, we haven’t been able to contain health care costs, which are significantly higher than the consumer price index. Payers are constantly looking for new ways to mitigate increased costs.

“Second is market changes,” he continues. “When Obamacare first began, the feeling was that in 10 or 15 years, insurance would no longer be linked to the employer. As we have found over time, this is increasingly unlikely, and the system of employer-provided health care will continue.”

Third is increasing investment in a lucrative business sector. “A large amount of private equity is being poured into health care,” Srivastava says. “The technological pace of evolution is attracting venture capital. Technology follows the money. The first major technology trend is big data and tapping into processing power that big data can provide. This enables us to give people the answers they need, when they need them.”

So, what are some of the latest trends for 2018?

Virtual care

Teladoc, a telehealth company in Purchase, New York, recently made several predictions for 2018. One is that telehealth is growing up: “The key to transforming health care is to make access to quality care convenient and easy. Virtual health uses technology, analytics and convenience to empower patients and overcome major barriers to care.”

Another prediction is that utilization will continue to take center stage as telehealth enters the mainstream: “As consumers’ comfort with digital health gives way to reliance on these tools, telehealth will fill the care gap with access to quality care, wherever and whenever they need it.”

These two predictions go hand in hand, says Dan Trencher, senior vice president, product and corporate strategy, for Teladoc.

“As telehealth continues to advance, covering more of the spectrum, it will help to further drive utilization, as employers have more opportunities to experience the convenience, quality and value of telehealth,” he says. “This will drive up ROI for employers and out-of-pocket savings for employees.”

Teladoc is working to expand access while improving the telehealth experience. “Our innovation will continue to be in expanding our virtual care delivery platform, enabling users to get answers to a larger array of medical conditions from one, easy-to-use, patient-centric access point,” Trencher says. “Advances in artificial intelligence will also continue, as Teladoc deploys smart guidance in our mobile app and websites to create a simple, personalized experience for members to find the care they need.”

Trencher has a tip for brokers: Give new technology a test drive so they can recommend it to their clients with confidence. “Brokers should get and use telehealth themselves,” he says. “Once they experience the value for themselves, their enthusiasm and passion for it will be contagious for the employers they are working with.”

Highly personalized recommendations

Healthcare is moving quickly from a one-size-fits-all approach to more specific recommendations. Evive is helping this happen by imitating two online powerhouses, Srivastava says.

“Evive is Amazon meets Google meets benefits,” he says. “Amazon provides personalized recommendations, and so do we, based on previous purchases, a profile of who you are and how you use the system for the right recommendations at the moment. We also are like Google in that you see recommended ads. We built an ad network that puts recommendations in your HR portal, application or payroll system.”

Ten years ago, Srivastava saw a growing trend in retail and applied it to health care. “We noticed how the use of retail coupons was evolving,” he says. “The discount paper suddenly became personalized to you. Healthcare, trying to become a more consumer-driven business, should do the same. Nowhere is it more important than in health. It provides the information you need, when you need it. We had the data but just were not using it.

“How about using the same technology, as it relates to personalized recommendations, in an area where it is sorely needed? If we can help people make better decisions about health, we are doing the basic blocking and tackling. How can you make better decisions when it is time to pick a drug or health plan?”

Simply put, Evive mines healthcare data to match individuals with the best care options.

After initially targeting large companies, the Evive concept is now cost-effective for small businesses, as well.

“Employers typically invest about $10,000 in benefits, and a lot of that is in health care,” Srivastava says. “Costs are rising 4 percent to 7 percent each year. The strategy to control cost is working with a bunch of providers. Our ROI comes from increasing the savings in each of those categories.”

Although the technology is cutting edge, the concept is simple: “It requires tools, marketing of tools, and measurement of those tools. The latter is what we do.”

On-site care

Providing health care benefits is one thing; maximizing their use can be quite another. On-site or near-site primary care clinics improve both health care and employee engagement, say Peter Dunn and Debra Geihsler, principals and co-founders of Activate Healthcare in Indianapolis.

Activate works with organizations to set up and manage primary care clinics as a benefit for their employees and their families. Organizations usually pay a fixed amount per month or a fixed amount for each worker and family member who has access to the clinic. No insurance claims are processed, and members and their families usually enjoy unlimited access at no cost to them.

“Clinics represent 5 percent to 7 percent of total health care costs, and organizations often reduce total health care costs by 10 percent to 25 percent,” Dunn says. “On average, organizations get back $1.40 to $1.50 for every $1 they invest in services. Demonstrated healthcare improvement—and avoiding related costs downstream—is the primary source of the savings.”

Dunn, a former CEO of a large business, and Geihsler, a former health care executive, started Activate in 2010. “We felt we were not giving good value to payers and patients,” Geihsler says. “We were not focusing on the person behind the health problem.”

Dunn drew upon his own experience of providing health care for thousands of workers.

“We had a huge health care bill,” he says. “The trends to provide excellent care to employees at a reasonable cost were not great. I had a background in product development and used it on unsolved problems in health care. I learned that three-fourths of costs are from chronic conditions. It was an ‘aha’ moment for me. Proactive primary care can have a dramatic impact on costs downstream. Employers are already funding all of healthcare, so why not do what works?”

Constant communication with clients and their employees has driven up participation percentages.

“People often ask, ‘How do you get more than 90 percent employee participation?’” he says. “Clients are involved in everything we do—who we hire, the name of the clinic, the hours and how we open the clinic. Everything we do is based on the people who are affected by the clinic. We meet in small groups with every one of the employees and their spouses, so everyone gets the full message. After it is launched, there is an ongoing process of communication.”

The ROI is both measurable and impressive.

“We measure ROI across all clients and the total book of business,” Geihsler says. “The ROI gets better after the second, third and fourth years. Some employers who have been with us for seven years see a 200 percent ROI.”

The result is win-win for clients and patients—and also brokers. “Brokers get more loyal clients by integrating proactive on-site care with cost savings,” Dunn says. “Brokers are at the table at every stage of the relationship.”

Another unique aspect is the three-year contract for companies that join. “This benefits brokers, who typically have a one-year contract,” Dunn says. “It locks in the benefit and cements the relationship between the employer and broker.”

Prescription for success

The care continuum also continues to address the availability and affordability of prescription medications. Express Scripts in St. Louis, which fills 1.4 billion prescriptions for 83 million members each year, leverages competition and market dynamics.

“Affordability and increased access to prescription medicine are the two factors that continue to drive changes in the healthcare industry,” says Christine Portell, senior manager, communications, for Express Scripts. “When affordability and access requirements are met, the result is better health outcomes.”

Express Scripts recently outlined three trends that are shaping health care:

• Value-based care. This protects patients and payers from skyrocketing drug prices while delivering better health outcomes.
• Personalized clinical care powered by technology. For example, pharmacists using remote monitoring can leverage data from sensors on inhalers or glucose meters to identify trends or gaps in care and perform counseling using patient-specific data, minimizing negative downstream health events.
• Data across the care continuum. The healthcare industry produces a large amount of data, but in many cases, information and insights derived from this data are poor. To effectively manage costs and care, and to take on national emergencies like the opioid epidemic, smarter pharmacy practice is needed.

These trends can benefit brokers as well as patients, Portell says.

“When we improve our support of prescribers, we’re ultimately improving patient care,” she says. “So insurance brokers will want to consider the significance of connected health care. Electronic prescription and prior-authorization channels are faster and more efficient methods to ensuring that patients are prescribed the most cost-effective and clinically appropriate medications.

“While fax machines have been disappearing from businesses and homes, they’re still a fixture in many medical offices,” Portell continues. “Electronic prescription and prior authorization eliminate the paperwork and time-consuming hurdles. The turnaround time for a decision is usually seconds to minutes, rather than the days it might take for a decision with a faxed prior authorization. Getting the right medication to the right patient in the most efficient manner is a major step in reducing costs and improving health outcomes.”

Advisory role

A comprehensive look at the expanding health-care continuum for 2018 and beyond would likely fill a book. The more pertinent question for brokers is how to best position themselves to thrive in this ever-changing world.

“Self-service options enable purchasing without the need for a broker,” Srivastava says. “Brokers must shift from a traditional model to an advisory model, just as Charles Shwab now is more of an advisor for investors.”

The best way to do this is to engage with the employers, who in turn engage with employees.

“The key to engagement is to follow what the rest of the world does,” he says. “If I am a retailer and want to sell something, I put my merchandise in the right place and display it the right way. Brokers and HR professionals need to think of themselves as product marketers. Benefits include a lot of products, so you need to make that product line attractive. Do what retailers would do. Provide the right message to the right population at the right time. Think like a marketer.

“If General Motors made a lot of cars and had no advertising to sell them, or if brokers bring solutions with no engagement tools, they are not realizing the savings they have.”

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