How Transparency, Technology and Data Analytics Are Transforming Employee Benefits [Part 1]

Artemis Health CEO Grant Gordon recently participated in a discussion on transparency, technology, and data analytics in the employee healthcare industry. We wanted to share some of the discussion and insights from this webcast panel with you, and we’ll be doing so over the next few weeks in this multi-part blog post series. 

In addition to Grant, the panel included Rion Shearer, Senior Employee Benefits Consultant at USI Insurance Services, and Lester J. Morales, Co-founder and CEO of Next Impact. Let’s dive into their discussion. 

Lester Morales:

Good afternoon, Good morning, depending on where you guys are at. We are super pumped about this as this subject is near and dear to basically everything that we do when we get up in the morning and think about how we're going to add value to this business.

Lester Morales:

We wanted to start with a little bit of a level setting on what should you take away from today. I think this subject of transparency of data and innovation with technology is not something that's just in our vernacular vertical here in the health benefits space. This is something that's involved in every aspect of our lives. So, when I think about what we're going to talk about today, I find it comical at times when we approach the health and benefits space, and we do so blindly. 

The reality of it is: you do not make any decision in your life without data points, but so often we are taking somebody else's. That person, a carrier, has a vested interest for a renewal increase. That's what they call revenue, and we trust that blindly. Oh sure. That's 15%. Sounds good. Oh, the best thing that we found in the market place is 6%. Says who? The reality of what we do in our business versus how we conduct our personal life is quite different.

Two is, and I've already hit on it: what we, our client and everybody call premiums, and the world of insurance calls revenue. I want everybody to ask themselves right now: when you wake up in the morning, do you ask yourself how to increase or decrease your organization's revenue? I don't think that anybody wakes up in the morning wanting to lower the revenue margin. Although, the way the world works today, that's exactly how most of our clients funding when it comes to their health benefits is, which gets me to point number three. I'm going to flat out saying I've been a self-funded guy since my career started 22 years ago. Now, the reality of it is: self-funding is the only way to go.

The last thing I'm going to leave everybody with is: I don't care what side of the IO you sit on politically wise. The reality of this is: the job of being a health insurance advisor is no longer a job. The reality of it is we spend so much of our country and our personal dollar on health insurance, and the reality of it is it's not getting any better. And, if it doesn't get better, the reality of it is it gets worse. And, if it gets worse, somebody else is going to take it over. Which means none of us are in the position that we're in right now.

Lester Morales:

I really urge everybody to think about some day with a clean slate that if we don't change it, somebody will come in and change it. So, I don't have to tell anybody and everybody that the reality of it is: health insurance out of control. The reality of it is both deductibles and co-insurances and the premiums that come out of employees’ and their family's pockets, it's just unsustainable. The greatest tragedy of this is it's not getting any better. Today, we're spending 18% of our GDP on healthcare, and the next potentially seven years we're talking about 19 and a half nearly.

The reality of this is we need to be part of the change. The reality of this is: we continue to do the same thing over and over again, and then act puzzled why a renewal increase is as bad as it is.

Lester Morales:

The reality of it is the transparency and the things you can do to save a significant amount of money, and there are brokers doing this every day. So, I brought with me today Rion. Rion is a fantastic partner of mine. Rion, I don't need to read your bio, but the one thing I have to make a joke most of the time when I'm introducing myself, I am saying that my degree is in Risk Management Insurance, and everybody asked me why the hell or how the hell I would ever get a degree in this, but you are somebody else that has this degree in Risk Management Insurance. So, I appreciate the nerd in you, but my question for you, for the audience, for everybody is: What's the number one thing that you hope that your peers, your other advisors out there...what do you hope that they take from our session today?

Rion Shearer:

Yes. Thank you, Lester. Welcome everybody. Thank you for taking some time today to listen to us talk to you a little bit about data and analytics, and helping you be better advisors.

Rion Shearer:

The number one thing that I hope, Lester, that everybody takes away is something that can help the end-user here: the employee at their respective clients and prospects. All of us who have been in the business long enough have heard enough stories about open enrollment, or from clients where employees can't meet their out of pocket costs or deductibles. There is a better way, and it's on us as advisors to arm ourselves with the right tools and the right information and partners to benefit these employees. Whether that's my local competition in Atlanta or anywhere else, I just hope that everyone walks away with something that can help them do something right for a client or for him to leave.

Lester Morales:

Right. For those of you who have never heard my story, I am the 68% of people that file bankruptcy for health reasons. My family, when I was 16 years old, had to file bankruptcy because my parents, two working people that had medical insurance, each at their respective organizations, their job, they could not afford the out-of-pocket max for four years in a row while my dad had two bone marrow transplants. It is something that I take with me every single day, and I appreciate that in you.

This is what we are going to do. We're going to talk to you about three main categories here in regards to just this concept and this conversation piece around data and transparency and technology. We're going to talk about access: how do you access data? What are there some tools and techniques out there that we need to be bringing to the marketplace to get better at getting that data, because without the data we can't make any of the decisions? How do we use that data?

When we have the data, how do we use it? And, more importantly, how do we improve the things that are working? Now, we're going to show you live examples of different things that have produced results, and I hope at the end of the day you leave the call with one thought: I need to do things better. And, better doesn't mean that anyone is doing it better than the other. It means that we could all get better every single day, and we should strive for it because the people that we serve, the employees that Rion just talked about, deserve more.

So, Rion, when we talk about access...it's an interesting topic about getting data. So, let's suppose that everybody understands the larger the group that they're already self-funded, they get some decent data. But, just data in general and getting to it, walk me through some of your thoughts and some of the techniques that you have used in regards to the importance of it. How have you seen that add value to you and your client, the challenges around it? What kind of obstacles have you faced then? And, maybe, though I appreciate you sharing it because technically everybody on this call is a competitor, but what are some techniques you use to help get some data? Or, some tricks of the trade?

Rion Shearer:

Yes. That's a great question, Lester. It took me a while to figure out these strategies and ways to actually get the data. I've learned a lot, I've figured out what to do, what not to do. I would say that the first thing is: the data is out there. The carrier does have it, and there are advances in technology that can help you get the data. Speaking around fully insured groups, here in Georgia we have a state code for title 33 that allows or mandates that the insurance carrier is supposed to provide claims experience on groups of 51 or more covered employees.

For starters, if it's 51 or more employees enrolled, our firm is leaning heavily on just the state regulations to mandate that the carrier provides us data. In some instances you may not get it, or maybe you may not get what you're looking for, so there is an opportunity, like I said, with some advances in technology to get that carrier renewal decision.

The other piece that's key, like I said about contracts, as you have larger clients, specifically on some of these level funded programs. In these contracts to provide a certain level of discount, how can I or the client identify that you actually met those discounts? And, you're right. We do have the data. Fill out this HIPAA form or PHI form, and we'll get you a file in a few days. Come to find out Cigna missed the discount by three or 4%, which created leverage for me and my team to reduce that renewal increase that we were faced with.

Lester Morales:

I think that is amazing, right? Because no matter what, everybody who is doing a job is doing the job based on the way they were taught, right? So, when we're dealing with the carriers, the person that we're asking and requesting to, they might have the greatest intent, right? We typically have a relationship with them; they're our accounts manager or something at the carrier. But, the reality of it is: they are going to somebody saying, "Hey, I need this data." And, typically someone's coming to them saying, "Yeah. Our standard answer is no until they ask them 17 times. And, after the 17th time, we get it."

So, yeah. I think one of the pieces I would just say is: demand more, but don't stop asking because the reality of it is in that example. If Rion wouldn't have drawn the conclusion that in order to hit performance guarantees, I need the data to be able to justify it, well, then that feeds you to two schools of thought for everybody in the audience. One: performance guarantees. Are you asking for performance guarantees and then defining how those need to be calculated? So, that is backing into a method of getting the data, because again, carriers say all day long how great they are and brag about this, that or the other, especially the word “discount.” Well, discount off of what? Well, in order to be able to calculate that you need the data.

The other thing is, I thought that that was excellent, and Rion and I had talked about this. I used to do this back in my Willis days. If you are not writing an RFP that has the wording, that the carrier who wants to win this bid needs to be able to provide the data that you need, and not just thinking about what you need right this second, but what might you need later, right? So, maybe it's a potential wellness client or an onsite clinic client, or using a data tool. The reality of this is you're going to need that carrier to provide data in order to be able to get it. That's one big way to do that.

Stay tuned for further parts of this blog post series on technology and transparency in healthcare data analytics. Want to learn more about Artemis Health’s software platform? Watch our 2-minute demo video now.

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Excerpted from How Transparency, Technology and Data Analytics Are Transforming Employee Benefits, published on October 7th. ©  2020 ALM Media Properties, LLC. All rights reserved.