Sitting in the Middle

Why did these organizations come together to create a national group?

We had investigated the benefits space for two years and decided to combine general agencies across the country. We wanted to build out and move east from California and become a national general agency. The other agencies that were integrated have all been successful in the states they were working in with carriers, and we felt like coming together could create something special nationally that serves and solves the needs of brokers now.

What did you determine the needs of brokers to be?

Brokers in California were selling in other places. Ones in New York were selling in California. We want to help everyone understand the different products and landscapes and territories. By combining, we thought we could offer the big things of a national general agency but have a local perspective on the ground in different states.

Also, there are a tremendous number of acquisitions right now. Little agencies are coming together; bigger ones are purchasing smaller ones. We had a myopic sense of how to deliver services—we were good at serving our community—and now we are connected to bigger agencies that may have a different offering than what we had. And finally, everything is getting smaller in the sense of how to deliver products to smaller employers.

For instance, Kaiser isn’t just in California; they have eight other regions. And when we talk with them now, we aren’t seeing them as a local player in New Hampshire or California or Maryland. Now we can look holistically at how to address each region with them.

So there’s a benefit of having the local background but a national scope?

Ninety percent of our business is still locally driven relationships and smaller groups and being good at what you do in the marketplace. What we want to do now is to seamlessly connect every point of the benefits journey from the broker, carrier and their collective clients. Our role is to sit in the middle of all of that and connect everyone at any junction point. We are in the midst of a two-sided market: insurance companies pay us, but our customer is the broker.

What do you envision as a better way for organizations like yours to work with brokers and insurers?

I have seen the industry go through ebbs and flows, and what I see that needs to change is there should be a more concerted effort looking at what the employer and employees are facing. Choosing benefits happens fast. It’s expensive, there needs to be more attention to detail, and it should be simplified.

Employers are trying to do the best they can, and to do that, a lot more cost-sharing is going on in many cases. It’s so important that the employee understand what is purchased and how to use it. For example, an employer has Blue Cross and they have sat down with their broker who has given them their options. Say they decide to change to United. That’s where we come in and do the work for the presentation and give it to the broker and support them through the process.

My point is, we have their attention because they have made a change. We could do a really good job at this point. If they were coming off an HMO and now have a high-deductible health plan (maybe a PPO, so there’s no gatekeeper), the employee may be in limbo if their kid gets sick. If they were in an HMO, they knew which primary care doctor to go to. Now, they have to find their list and see who is in their network.

This is where I want to make a difference. As soon as they fill out their enrollment, we could send a text or other communication saying, “You chose this. How it works is like this. If you need a doctor, you can go here or go to urgent care. And for prescriptions, you can go to Walgreens but not CVS because they aren’t in the plan.” Up until a person can get into the online portal, it makes sense to do something like this. This is when they are paying attention and we can help them move forward through the process.

This is the conversation I’m having with carriers, letting them know we can do a better job. They just have to change the lens in the way they view our role. We can help them have customers that know how to use their plans at a greater level.

Would that kind of work be slightly different for each employer, depending upon their needs?

We have to work with employers to see what is important to them. Some small employers don’t have human resources staff, so their issue would be “how do we make sure employees are getting the same level of attention and education when they make that change as a larger organization?” We are finding brokers that are like-minded and understand they need to do more to help in that situation. And we are finding brokers invested in that level of understanding that goes beyond just making a change in benefits. There is an increase in high-deductible health plans, and something that is going to have to be conveyed to employees will be that they have first-dollar coverage. They see and choose these plans, but do they really understand what it means for them and their families?

What does it mean to work with brokers who have a similar business mind?

We do quoting, spreadsheeting and enrollment, scrubbing, cleaning and underwriting of group plans and facilitating of renewals. We focus on the platform and understand how to navigate within that platform. The new broker knows that all of this is happening together.

We are looking at the process from the standpoint of data, which turns into action, and action now moves into a product. That product needs to be maintained and sustained through support. Brokers are relying on us being general agents to help them more and more with renewals and maintenance with these groups. The relationship normally ends when a group is approved, and renewals and ongoing maintenance and eligibility are done by brokers. But we are getting more and more requests to help facilitate that. I think things have become a little more complicated and brokers are needing aggregated support. Understanding the needs of the employer and their pain points requires a lot of preplanning.

What does that look like from a practical standpoint?

We can create heat maps to see where a carrier is fitting in by product line—like Anthem with a PPO, HMO or HDHP—and see how it stacks up in a certain area. We can look at a heat map and see where groups fall into certain categories. We can look at these 50 groups a broker has, estimate who might be changing at what price point, and be a little ahead of it. Then, when a group comes to renewal, a broker is going to know where that group fits based on the heat maps. They can be prepared and have the information ready.

I know what a general agency needs to do and what a broker needs to do, and we can all focus on making the experience better for the employee.

The days of all of us not understanding how our benefits work and how much things are going to cost should be gone. Everyone is trying to figure out whose role it is to help with that, and someone just has to take charge. In the end, I want to be able to help solve that. Even if I only have a tiny sliver of groups that come through us and use the platform, they should all have a better understanding of how to use their benefits.