Attending this year’s Medical Captive Forum in Chicago was an eye-opening event into the world of self-funding. It was a wealth of information, an opportunity for employers and advisors across the country to come together and learn about an innovative solution to manage out of control health insurance costs for small and midsize businesses: self-funded health insurance in a group medical captive.
A group medical captive allows small to midsize companies to pool together risk so they can self-insure with the same risk predictability as a Fortune 500 company. Roundstone’s Captive pools over 700 companies and protects over 120,000 lives.
But one truth rang loud and clear from the experiences of self-funded employees: the quality of your advisor is absolutely critical to optimizing the savings potential and other advantages of a self-funded health plan.
But what makes a great advisor? How can you tell if a benefits advisor or broker has your company’s best interest as their top priority? And if you don’t feel you’re in great hands, how do you find the right advisor for you?
Here are the top 10 qualities to look for in a benefits advisor to ensure a great experience with your self-funded benefits plan – one that reaps the greatest savings while still providing top quality benefits for your employees.
1. A great benefits advisor is open minded – and doesn’t sell by spreadsheet
A great advisor is result-oriented, research-based, highly knowledgeable and proactive when it comes to implementing solutions that benefit their clients. They’re open minded and seek out innovative solutions – and that includes a captive solution for self-funded health insurance.
They don’t just sell according to unwieldy spreadsheets that focus on price and don’t tell the whole story. A good benefits advisor is an informed one, and employers need to understand how various components of the captive solution work together to save money, often greater than any other “discounts” being offered. These include annual distribution of unspent captive premium, PBM rebates, and proactive claims cost management. Presenting only max costs as a line item on a spreadsheet is pushing the easy button, and you generally want to avoid this type of transactional broker.
An open-minded insurance benefits broker recognizes the dynamic nature of the insurance industry. New insurance products, coverage options, and regulatory changes continually emerge. By embracing a mindset that pursues ongoing learning and adaptability, brokers can stay up-to-date with the latest developments and solutions that benefit their clients. They continually ask pertinent questions to gain a deeper understanding of your benefits needs and provide the most suitable solutions to lowering benefit spend without sacrificing quality.
2. A great benefits advisor is aligned to your company’s best interests and prioritizes your employees’ well-being
A great benefits advisor understands their success is intrinsically entwined with your own. They always prioritize the plans that deliver you the best savings and the highest quality care – not which insurance company takes them golfing or pays a big fat bonus. It’s a question of alignment. Sadly, misaligned incentives are the primary driver of skyrocketing insurance rates.
By putting their clients’ interests first, brokers work diligently to understand the unique goals of the employer, helping them find suitable insurance plans that align with their budget and coverage requirements. They work for you – your best interests and well-being should be their highest priority. This is the Roundstone way. We believe that being aligned this way lets you be plenty profitable without losing sight of why you are in this business in the first place – helping employers get better benefits at a lower cost with full transparency.
3. A great benefits advisor understands the value of a long- term strategy for a self-funded health insurance plan
A great benefits advisor understands that the strategy that drives a benefits plan should be a long game. It’s not just what you save now but for several years into the future.
A self-funded health plan generally provides about an annual 20% savings over a traditional fully insured plan. As that savings accrues, the benefit can be substantial. But the greatest savings is long term as the plan is adjusted using data-driven cost-saving strategies to further improve savings and reap the greatest potential.
That’s the essence of the Roundstone Guarantee: We promise you’ll save money in the first five years or we’ll make up the difference. In fact, two-thirds of our customers save enough in their first four years with us to pay the claims for their entire fifth year. And 100% save money, full stop.
4. A great benefits advisor prioritizes lowering your per employee per year (PEPY) price point
With skyrocketing costs, small to midsize employers look to lower their cost to insure their employees without degrading the quality of care. This is measured by the per employee per year (PEPY) price point – how much your company spends on health insurance for each covered employee.
PEPY can come in handy because it allows you to analyze annual trends that drive your healthcare costs. Lowering your PEPY should be the number one priority for every benefits advisor because it’s critical to controlling your healthcare spend. And through data-informed cost saving strategies available via the group captive, PEPY can be lowered without degrading the quality of the healthcare benefits you provide employees.
Ask your benefits advisor what they can do to lower your PEPY costs. That should be their primary incentive in finding you insurance solutions. It’s simple math: Do they have a plan to save you money on healthcare or not?
5. A great benefits advisor prioritizes lowering prescription costs and has a plan to do so
Drug costs are by far the greatest opportunity for cost savings in a self-funded health plan. Prescription drugs are projected to rise 7% annually, comprising an even greater share of all healthcare spend going forward.
About 30% of a group’s prescription costs are specialty drugs – these are typically the drugs you see advertised on TV. As a general rule, if a drug’s advertised during a Monday night football game, it’s going to drive up the cost of any health insurance plan exorbitantly. Even if you have a traditional fully-insured plan, you’ll pay for these costs and then some in annual rate hikes that gouge your bottom line.
Controlling pharmacy costs should be a critical concern for any employer looking to lower healthcare spend. Ask your benefits advisor what they plan to do to lower your prescription costs and if their plans prioritize prescription savings. This should include providing plans that use pass-through Pharmacy Benefits Managers (PBMs) that pass medication savings on to you instead of the insurance company or the advisor. It’s your money, your savings – you should keep it and be the one who benefits.
6. A great benefits advisor understands the value of data and the power of cost containment
The beauty of self-funded healthcare is it provides actionable data you can use to adjust your plan to drive down costs and increase the savings potential of self-insurance. A great benefits advisor will understand the value of this data and how it can be used to drive down the cost of healthcare.
At Roundstone, we have a dedicated CSI team of clinicians and data specialists who comb through your data to identify cost-savings strategies to improve the savings of your self-funded health plan. We work closely with you and your advisor to identify your biggest healthcare expenses and recommend easy-to-follow solutions to further save you money. It’s a seamless, guided process that can make a world of difference to the savings of your self-funded health benefits plan. Look for an advisor who understands the value of data insights and how to make them actionable to optimize your plan and care quality.
7. A good benefits advisor understands the power of good plan design in serving your employees’ unique healthcare needs
Every company is unique and has specialized healthcare needs specific to the individual concerns of its employees. Healthcare shouldn’t be a one-size-fits-all package. A self-funded healthcare plan can be customized to fit your employees’ unique healthcare needs, improving the quality of care while simultaneously lowering the expense.
Choosing the right advisor is crucial when implementing self-funded health plans. An effective advisor exhibits traits like collaboration, advocacy, and a long-term perspective.
They work closely with employers, understanding their unique employee needs and financial goals. A dependable advisor advocates for cost control and the delivery of quality care, ensuring employers get the best of both worlds.
By challenging the existing norms and status quo, advisors set themselves apart. They bring innovative solutions to the table, leveraging their expertise to navigate complex healthcare landscapes, improve outcomes, and prioritize employee well-being.
A good benefits advisor will understand the significance of good plan design. They will help you construct a high-performance plan that evolves over time and offers flexibility and options to better serve the unique needs of your business and your employees.
8. A good benefits advisor involves their partners
There are a few different solution providers who come together to support a self-funded health plan – Third-Party Administrator (TPA), Stop-Loss Insurance Carrier and Pharmacy Benefit Manager (PBM) and other specialist cost containment and wellness solution providers.
Every employer who self-insures receives seamless support from these organizations to implement and administer the plan, manage and pay claims, optimize plan utilization, and analyze and contain costs.
These organizations are naturally experts in their offerings and are best positioned to answer questions and explain the benefits. A good benefits advisor will involve that partner directly in discussions with you. This removes any barriers of communication so you get the information you’re looking for directly from the source.
For example, our top advisors involve Roundstone in their initial meetings with employer groups. But it’s not a sales pitch. We’re just in the best position to explain how the Roundstone Captive works and answer specific questions and concerns. It’s like having the head chef guide you through the menu of their restaurant – all the ingredients can be explained in detail.Together, we can provide the most insight and value.
9. A good benefits advisor charges commissions based on Per Employee Per Month (PEPM) – not a percentage of the premium
Want to pay outrageous prices for healthcare? Hire an insurance broker who charges their commission based on a percentage of your premium – the actual cost of said healthcare. Yeah, that’s about as nuts as it sounds once you say it out loud.
It’s a question of incentive alignment. Why should your insurance agent make more money by providing you an expensive healthcare solution? It’s their job to find you affordable health benefits without sacrificing the quality of care. You shouldn’t pay them more just because they failed in their mission to be cost-effective.
Broker commissions should always be based on the number of people you are insuring – not the cost to do so. If their commission is based on percentage of premium, they are not representing your best interests.
10. A good benefits advisor values education and information
You know you are in good hands with an advisor when they help you to understand and improve your long-term health benefits strategy. Industry events and engaging with the self-funding community are an effective way to stay on top of trends, best practices to help you succeed in your job.
One of the best educational events around is Roundstone’s annual Medical Captive Forum. MCF is your ticket to learning proven strategies for the best experience and the highest potential savings out of being self-insured in the group captive. You’ll hear fresh perspectives, develop new relationships, forge transformative connections, and discover innovative approaches to self-funding that will blow your mind. MCF is a great opportunity to educate yourself and stay on top of self-funding trends, especially when it comes to group captive solutions.
Your advisor should be all-in on this kind of educational experience – and if not, it might be time to find one that is.
Finding the Right Advisor
There’s never been a better time to be a benefits advisor. The health insurance industry is hungry for new ideas and fresh energy, and there are many advisors who are looking to be agents of change, bringing new technology, high energy and a new way of thinking about serving clients. Interestingly, there are new advisors coming into the industry, who are the young guns, looking to do things differently, and there are seasoned advisors who are looking to transform their career. Both are looking for higher job satisfaction and a better life for themselves and their clients by focusing on the traits we have outlined here.
Watch out for the status quo advisor. These tend to be legacy brokers comfortable with pushing the easy button. They are price/rate shoppers and not really interested in being a consultant or a trusted partner who is aligned with better long-term management and stability of your healthcare costs.
Need help finding a new advisor? We’d be happy to make some recommendations from our trusted network. Contact us for a referral.