TO START FIXING HEALTH CARE LET’S START WITH SOME TRUTHS (My Ideas)


This was my first post on my other blog titled, New Health Care for America. I am republishing this here because this is a different audience. It is intended to start discussion.

To start my blog about fixing health care I thought I would start with just making some comments that in my heart of hearts I believe to be true. These are random thoughts but my thoughts. Anyone who wants to add to them feel free to jump in.

Most Americans want everyone to have access to health care.

Providers of care, generally care. They want to do good.

Our chaotic pricing of health care is caused by our financing model. Everyone has a deal, and everyone is trying to push the cost onto someone else.

Our health care financing system is the cause of escalating health care cost. Fix health care financing and you will reduce health care costs. The insurance industry thinks it is the other way around. I disagree.

We will never fix the system until the incentives are properly aligned. Providers of care need to be rewarded for keeping people healthy and being efficient.

Employers don’t want to be in the health insurance business. Most would get out if they could.

Employers are blocking access to higher quality and more affordable health care. I will write about this one. 

I can lower my own costs easier than my employer.

Health insurance should not be tied to a job.

I want all my health care information in one spot.

Artificial Intelligence can possibly save my life. However, it can’t work if my data is scattered all around. 

I want my doctor to have all my health care information so he/she can properly advise me.

I don’t want my employer to be involved in my health care. 

I want my doctor to be incented to keep me healthy.

I am never going to understand how the whole system works so it better be easy or I need someone to guide me through.

On second thought, it should be so easy nobody would need a guide. 

When people have health issues, they don’t want to be worrying about how to navigate the system.

Low cost care, like office visits and tests, should not be insurance. Insurance is designed to protect oneself from an unanticipated event that could cause long term financial harm.

Health Spending Accounts are a good idea.

If the government wants everyone to buy insurance, then it should be with pre-tax dollars for all.

Everyone in the system thinks the other guy is ripping them off. Health insurers blame the providers and the providers blame the insurers. The brokers blame everyone. People should look in the mirror. 

The whole country can run on 10 health insurance options.

Revision – after talking to some people, I think we only need 5

Fee for service needs to go away.

Price transparency is a feel good, bad idea. It won’t fix anything. Which is why fee for service needs to go away.

Health insurance should not be a 1-year term policy. You insurance people know what I mean.

Health insurance should be a whole-life policy.

As long as we have rules that let people game the system, they will.

Employers are dumping their bad risks into the individual market if they can. This is one of the games.

The government is the biggest driver of escalating costs through tax policies.

Most health care dollars pay Americans. If we reduce costs 20%, who is losing?
I think we can reduce administrative costs to around 5%-7% but not under the current system.

Everyone should watch Mark Bertolini’s presentation to the Mayo Clinic. He presents the future of health care. https://youtu.be/7LVSj0JcD2A

Webinar Invite – Introducing a New and Transformative Employee Benefits Model


April 7 – 12:00 – 1:00 EDT

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We would like to invite you to be a part of something new that will transform the employee benefits business. Between new technologies, new laws, a changing workforce, and what we call the “new math” of employee benefits, the opportunity to help millions of Americans improve their financial health and access better health care is here. However, getting the message out and challenging the status quo takes an army. We want you to consider being a part of this movement, our army, to pave the way to a much better benefits and health care future.

In this webinar we will cover the following:

  • Our Why – The Vision Overview
  • New Technologies that enable this change
  • The Old Math vs. the New Math of Employee Benefits
  • The Solution Overview
  • Improving Heath Care
  • Benefits to Employers and Employees
  • Target Market Opportunities
  • Why and how you should be paid

We think this will be invigorating, exciting, and thought provoking. It will create a “spring in your step” because after you hear about what we are doing the creative mind will start working.

To register for this webinar, click on the Register Now link. Please note that this webinar is for select Benefits Brokers, Payroll Companies, HR Consultants, Retirement Advisors, and Accountants. N4one reserves the right to not accept someone into the meeting who may Register. If you have any questions and/or review your participation, please call 508-498-7591.

Webinar Invite – Deliver the Advanced ICHRA – Moving Beyond the Obvious


January 28th and February 2nd  – 12:00 – 12:30  EST

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You have probably gotten invited to many ICHRA Webinars. This webinar will be different. We think every broker will be able to deliver an ICHRA. We have the Advanced ICHRA. In this webinar we get into the weeds. We identify the gotcha’s. We bring ideas that most have never thought of. We will identify sales tips that can make a difference. Then we will introduce the Advanced ICHRA.

In this webinar we will cover the following:

  • Review the Consulting Process
  • Steps to Execute an ICHRA
  • 5 Gotcha’s that Cause Problems
  • Review of the Vendors
  • Delivering the Advanced ICHRA
  • How to Win with ICHRA’s in 2021

Don’t ignore the ICHRA. This will be bigger than most think. We get into the weeds identifying things few have considered. To register just click on the Register Now Button.

Webinar Invite – Bring a Unique New Benefits Solution to the Market


January 14th and 19th from 12:00 – 12:30 EST

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Do you want to challenge the status quo of benefits and bring a new idea to market that can grow your business? In this webinar we will introduce a new idea and demonstrate a new product we are bringing to market. We think the current benefits market is very broken and we will show you some data that supports this that will astound most brokers. Working with some MIT Technologists we have developed a new model that benefits consultants can deliver that can improve an employer benefits program and bring more value to employees.

The Agenda is as follows:

  • Why the Current System is Broken
  • The Data That Supports It
  • A New Benefits Model
  • The New Formula for a Modern Benefits Program
  • The Marketing Campaign to Grow Your Business

If you would like to attend just click on the Register Now button. If you have any questions, please feel free to reach out to us at 508-498-7591.

N4one Launching New Employee Benefits Platform


We are happy to announce that our new employee benefits platform, “Employeaze” is launching on February 1st. We do not want to share all the secrets publicly here yet, but this system fills some gaps in the market that we have recognized for some time. For brokers and others such as payroll companies or HR Consultants wanting to bring something new to the market, it is an opportunity.  For those who know me I have been consulting in the HR/Benefits/Payroll technology business since 2001. I have worked with hundreds of employers, implemented systems from over 30 vendors, and have tracked hundreds of vendors along the way. Our new solution delivers a whole new employee benefits model in a streamlined way to the small to mid-sized employer market. And no, we are not another benefits enrollment system. I think we fit in our own box right now.

For those interested in learning more, feel free to reach out to me and we can schedule a call. Send me an email @ joemarkland@n4onehr.com .

Webinar Invite – How to Get the January BOR


December 3rd or 8th – 12:00 EST

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Are you looking to grow your business in 2021? Then why not start now. In this webinar we will show you how using the New Math of Health Insurance can improve an employer’s benefits program and employee satisfaction for the same or less money. This compelling differentiator can generate a sense of urgency for the employer to act now because every month the employer delays may cost their employees money. A renewal that was thought to be “put to bed” will be reconsidered because this option was not shown by their current broker. This can be the wedge to get employers to change their broker immediately.

The Agenda

  • Why a Renewal May Not Really be “Put to Bed”
  • Review of the New Math of Health Insurance and Benefits
  • The Value Proposition for Employers and Employees
  • How to Create the Wedge
  • The Marketing and Sales Plan
  • The BOR

This webinar is for those brokers who want to grow their business and start 2021 with a bang. While some are taking a break after the renewal season you can get on offense with whole new benefits program. To attend this webinar, click on the Register Now Button.

Webinar Invite – The New Math of Health Insurance


The Key to Cost Reduction for Years to Come  

November 5th From 12:00 – 12:00 EST

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  What if the math you were using to advise your clients around health insurance was wrong? What if the decision support tools employees are using are wrong? In this webinar we will show you a whole different approach to the Math of Health Insurance that can impact an employer and employees health insurance decision. Some of you may have figured this out already, but I have spoken to hundreds of brokers and few have realized this “New Math”. And this New Math can pave the way to lower insurance costs for years to come. 

The Agenda
–    The Old Math
–    The New Math
–    Impact on Employers and Employees
–    How to Present to an Employer

This is an “eye-opening” webinar that will be well worth 30 minutes of any benefits professionals time. If you would like to attend just click on the Register Now button. If you have any questions give us a call at 508-498-7591.      

View Webinar – How 1 million+ MA Employees Can Reduce Health Insurance Costs Now


I just conducted a webinar that may be of interest for MA brokers or employers. Here is a link to see the recording.

View Recording

For Benefits Brokers viewing this I just want to let you know I work with brokers but am not a broker. I do sell non-broker services direct to employers but am not a licensed agent. I also consult brokers and provide tools and resources for a fee. Call me at 508-498-7591 if interested.

Webinar Invite – The Transformation of Employee Benefits


For Employee Benefits Brokers

October 27th and November 4th

12:00 – 12:45 Eastern Time

“If everyone is thinking alike then nobody is thinking.”
Ben Franklin
REGISTER NOW
The wheels of change are in motion and employee benefit programs offered by employers have started the move to a whole new benefits model. Employers are welcoming this change, and employees are reaping significant financial benefits. It is “transformational”. In this webinar we will present this new benefits model and outline how benefits brokers can separate themselves from the pack by delivering a unique and compelling value proposition. Many brokers may see this as a threat to one’s current business, but we think it is an opportunity. This can be your Netflix or Blockbuster moment. Let’s make it a Netflix like moment.

The agenda is as follows:

* The Foundation for Change
* What the Democrats and Republicans Agree On
* How Group Health Benefits Could Go Away Fast
* The “New Math” of Employee Benefits A
* New Employee Benefits Model
* Introducing a Proprietary Solution for Brokers
* The New Revenue Model

This webinar provides brokers a plan to thrive in a changing benefits world. To participate just click on one of the Register Now buttons. If you have any questions, give us a call at 508-498-7591.

REGISTER NOW  

How the Next Executive Order Could and Should End Employer-based Health Insurance by 2023


Over the past 6 years I have published several articles on the need to personalize health insurance (and get the employer out of the way) by making an individual insurance policy tax deductible. This happened partially through the introduction of the Individual Coverage HRA (ICHRA) which was effective January 1, 2020, but it did not go far enough. Since the ICHRA became effective I have analyzed 50+ employers across the country comparing their group health insurance program to alternatives on the individual market. While not all individual markets are competitive at this time, I have seen enough evidence to conclude that the move to a total individual insurance market is inevitable and it could happen with one quick stroke of the pen. The benefits of this change can be tremendous. Employees throughout the U.S. will reap benefits through lower costs, more options, and ultimately better health care.

The running narrative around employer-based insurance is that it is not broken. I disagree. An interesting statistic, that few in the business have realized, is that the number of employees covered under employer-based insurance is the same today as it was in 1998 while the population has been rising. (Source: Kaiser) Deductibles and employee contributions have also increased at rates higher than inflation and wage growth, creating a working poor population. (See chart below) I do not know how many more non-profits or home health care companies I need to look at that have 30% participation to support my position.  

I have recognized a few things while analyzing the 50+ cases. First, I will say that employers are over-buying insurance for most employees. One size does not fit all and many employees, when given options, would choose more narrow networks with slightly higher deductibles and fewer pre-deductible copays if they can benefit from the decision. In Massachusetts, the average individual insurance buyer is choosing a plan that is 14.4% – 33.7% less expensive (depending on income) than the average large employer. (Source: MA Health Connector) This frees up an average of $2200 per year that can go towards a health savings account or maybe pay down one’s credit cards. Employers are forcing employees to pay more for health insurance leaving less money to pay for actual health care. Funding an HSA will make money available for first dollar care.

Another issue I am realizing, though I will not get into all the details here, is that the majority of the “decision support tools” guiding employees current buying decisions through employers are flawed. This is a big statement that will get some pushback. I will cover this in another article and back it up with data. My only point here is that these tools are also contributing to consumers over-buying insurance. Few who are buying health insurance have a true understanding of their real risk.    

The current model of group insurance is a one-size fits all model. The employer buys one or a few options and asks employees if they want to participate in this employer purchased insurance. I have to ask, where in our personal lives does one size fit all? Everything is becoming personalized. Consumers, when acting in their own best or selfish interest, can make decisions and drive down costs. The employer in the middle is the problem.

Another belief is that employers have more buying power than an individual. That really is not true. Individual insurance is negotiated with the States and the individual market is one big risk pool. In most States insurance companies have tens of thousands of employees in their individual risk pools underwritten as one big group. Also, when one looks at the cost of running an individual program it is often 5-6% less than running a typical group program.

The current market depends on two things to “release the power of the markets”. First it requires the employer to “give employees the freedom to choose” by adopting an ICHRA. The second is the health insurance companies need to rethink their position on the individual markets. States can also lead the way by adopting the MA model of pricing health insurance. I have looked at all 50 States and MA has it right. In Massachusetts, individual and group pricing are required to be priced as one risk pool. In prior articles I have written that splitting risk pools is a key cause of the problems with the U.S. health insurance system. By putting individuals and groups in the same pool it stabilizes the markets and stops the gaming of the system by employers seeking better risk pools. For those thinking the that employers managing risk through all types of crazy cost containment programs is something they want to do I would argue that most would prefer to simply be out of that business.     

This gets to my prediction, and a possible solution to saving the private health insurance markets, driving down costs, and ultimately improving consumer health care. Through Executive Order, the President (whoever it is) can make an individual insurance policy an eligible expense under a Health Savings Account. By doing this the employee could be in control, not the employer. An employee can ask the employer to pay them the money instead of buying their health insurance, giving the employee the option to buy what they want. The insurance companies would respond to this new demand and start focusing more on the individual market. Capitalism and market forces can work, if we let it.

This change could happen under a Trump or Biden Presidency. Trump has already indicated that he intends to expand options. Secretary Alex Azar said in September 2020 that, “We’ve created new ways for workers to have a broader set of insurance options through Health Reimbursement Arrangements, and the president pledged last week to push for more reforms to open up even more options.” These more options could be the Health Savings Account.

Biden’s big push is for a Public Option. I would assume the Public Option is chosen by individuals not employers, so he would be in favor of maintaining the ICHRA rules and possibly expanding individual choice. I want to add that I really do not understand the deal of the Public Option. If the hospitals and doctors would accept Medicare type reimbursements right now from any insurance company, they could do it without the government being involved. The Public Option could be run through a private market today if the providers would accept lower reimbursements from private plans. The current problem is the providers need the private markets to subsidize public plans. This may play out soon.

The move to a consumer-centric model based around individual health insurance is inevitable. I think employers, employees, and providers would welcome the change.  It is an easy change because the individual health insurance markets and Health Savings Account Administrators already exist. Much like the ICHRA, with one stroke of the pen, tens of millions of Americans can be choosing their own health insurance in 2021. Employers can provide money to employees for health insurance as they are today, but when it comes to choosing health insurance they simply need to get out of the way.