Welcome to Health Benefit Resources, Inc.
Our Mission Is Compelling – On-Site Clinics Are the Fastest Growing Health Initiative. We will work with an individual employer or group of employers banding together within a community to establish an on-site Primary Health and Wellness Center for all of their employees and their families. They will have access to the clinic’s Health Improvement and Primary Care Services, inclusive of a full-staff of doctors and clinicians predicated on the size of the participating group. Employees and families will access these services at NO cost to them and most generic drugs are provided free of charge, as well.
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IN THE NEWS
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Your Agency Can Become Irreplaceable By George V. Duczak
The group marketplace will experience a dramatic change in the next decade…And It Has To! Group medical rates that double every decade are just simply not sustainable. Like the old adage states, “if you find yourself in a hole, stop digging”, I think we have now come to that point!
Fortunately, the majority of employers have continued to provide medical coverage, the second highest cost, and most appreciated benefit. However, to maintain any type of affordability, employers have been forced to increase employee premium contributions, which has been draining the income, particularly that of lower-paid employees and their families, while at the same time, burdening them with increasing high-deductibles and out-of-pocket costs. We are finding that the most harmful effect is the deteriorated access to Primary Care and as a consequence, contributory to the huge increase the industry is experiencing in catastrophic level claims.
In the large employer market, those with 5,000 or more employees, growing implementation is through the creation of Employer-Sponsored Primary Care Centers. Currently, approximately one-third of all large employers with over 5,000 employees have a Center and a like number have indicated that they plan to do so in the near term.
I have attended numerous professional conferences and have met with many major employers. I have heard about the success and satisfaction they have gained by investing in these Centers. Employers have found out that it conveys a sense of commitment to their employees that they are their most valuable resource while at the same time, significantly improving their benefit structure through NO COST access to Primary Care Services. The collateral benefit is that the Centers have in fact been able to improve the overall health of the employees, which in turn is a significant contribution in reducing overall Major Medical costs.
Another interesting fact is that approximately one-third of the Centers have been equally adopted by the public sector, organized labor, and commercial business employers. Obviously, these large employers have the resources to build-out their own Centers. In fact, many of them are now reconsidering the whole structure of how they address their medical costs in regard to PPO Networks and even to revisiting administrative services. Many changes are going to occur, and I believe the agency of the future has to be a participant in this new and exciting future.
After selling my major agency, I have become fascinated with this trend. I also found that it needs to be enhanced in order to be appealing to the smaller employer. Working with one of the fastest growing managers of these clinics, we have been able to affect a breakthrough in being able to offer and create an Employer-Sponsored Primary Care Center for Employers with as Little as 10 Employees. Our initiative eliminates any upfront capitalization and implementation costs and converts this into highly affordable monthly access fees.
A recent survey indicated that over 85% of employers still rely on their insurance agent or advisor in providing or administering this highly necessary employee benefit. They also state that employee recruiting and retention has been negatively impacted when their health plan has these significant out-of-pocket costs or contribution levels, particularly in such a tight-fitting labor market. Therein, I believe, lies the opportunity for the visionary agent.
Being able to offer an Employer-Sponsored Primary Care Center means that we are now able to provide a vehicle for smaller employers to band together and use the services of the Center. This group of employers can consist of employers within a geographical community, an industry sector or a regional development center, which also provides interesting potential. An agency often begins by offering it to their existing client base as a highly valued feature. We can open up a clinic with as few as 500 employees, which typically means about 800+ lives. The added appeal is that as the agency is the trusted agent of record for the program, the Center can provide an outstanding new client recruiting tool.
So How Do You Get Started
My company assists in the financial support for this initiative in the actual establishing of the Center in partnership with our Clinical Manager. We also provide a communication, marketing and sales management platform. We then develop databases using our new social and business communication media to create interest in the program.
Growth is vitally important because beginning with a smaller level of employers, the initiative can broaden into the creation of an association-based plan, but only for collective sponsorship. I am still somewhat apprehensive here under the new proposed association rules for collective risk pooling. Our approach prefers that each company be individually rated and financially responsible. We would assist should these groups migrate to some form of partial self-funding, typically in a max level funded type of arrangement.
Beyond that, we will get into the area of the underlying Major Medical Plan. There is competition within the medical community, as Value-Based Reimbursement methods are being adopted and can play a further role in managing long-term costs.
Often times employers will look at the implementation of new programs on an incremental basis and we do support that. With the creation of the local Center, the agent and their client can still continue with their current Major Medical Plan if they are satisfied with it until such time as we can develop definitive utilization trends and costs.
There are many challenges and complexities to the implementation of this program and that is even further reinforcement for why a professional benefits advisor is critically central.
We are seeking such agencies as our partners in this undertaking and would appreciate hearing from you.
George V. Duczak
President, Health Benefit Resources, Inc.
The Community Care Partnership
Combining best-in-class services into a dynamic three-part program
For Health Insurance, The World Is Upside Down AGAIN!
In March 2010, before ACA was enacted, I wrote a predictive article that was published in HIU Magazine titled “Medicare, Medicaid, & MediChaos”, sadly; this forecast has come to fruition.
Our clients are asking us, as their benefit advocate, to give them guidance with this new level of uncertainty under the Trump administration. What needs to be complied with or not and what can we do immediately to hold the line on group health insurance costs without subjecting our employees to unbearable out-of-pocket costs?
How Do You Answer This
First of all, as to Compliance – Nothing has changed! Most of the regulations will remain until the Senate comes up with a new modified bill, which I don’t believe will occur until 2019. I feel that on a continuing short-term basis, Congress will continue to fund this ACA subsidization, as the prospect of market turmoil in a 2018 election year is ominous.
As to the second part, Controlling Costs – In all my years in this business, I have seen every machination imaginable populated heavily by acronyms that always promised to be the silver bullet. But, we continue to kick the can and indicate that a solution is coming and that the one we offer today will help. Then the question is if you revisit your recommendation two years later, did anything really get accomplished? The lack of quantitative data and pricing transparency makes it very difficult.
Are There Solutions
Yes, emphatically! In my opinion, the solutions would involve a reconsideration of the way benefits are offered, delivered, and how health care is truly provided.
What is a visionary fit for a Benefits Producer of today and tomorrow? It is to become the center of a health care benefit delivery and funding system within their community and community of clients. You need to get beyond health insurance and go to the root causes.
How Do You Do All This
- Evaluate your population and data. Look at your client’s rates for the prior 5 and 10 years and forecast what will happen in the next 5 years. I am finding out in the Illinois marketplace that on average a 100 employee group suffers an average cost of $1,000,000 annually. How would you like to receive a monthly bill for $80,000 whether or not your company is doing well? If you don’t pay, the consequences are severe. On top of that, just think of what an employer has to generate in revenue to pay that amount. In essence, if a company has a 10 percent annual growth in income, does this mean they would have to have $10,000,000 in total sales to cover a million dollar annual liability? This is certainly daunting! Also realize that this number will escalate and compound year-after-year.
- You can’t give everybody everything for nothing! In essence, the old adage of spreadsheets and the particularly onerous network match is stifling success. If you are going to manage the health care cost side, you have to be able to provide product options to the employer and their employees with the best cost and service delivery system in your local community, which may or may not even include a network in the future.
There can be integrated financial relationships between local businesses, benefit agencies and the medical community but everyone has to think out of the box. Some options include reference based pricing and closed or tiered networks. Promising employees that they can go wherever they want and get everything they want results in a pricing TSUNAMI!
- If your group has the right characteristics in terms of demographics, employer size and an indication of health characteristics of the group, moving to partial self-funding or modified funding is advised. The likelihood of future threats of taxation on employer delivered benefits or state-by-state experiments will not reduce costs. A self-funding program can have a double-digit sustainable decrease in cost reductions that benefit from good management but only if you can integrate the right partnerships!
- Start offering a Direct Local Primary Care option. This may take the form of a Direct Primary Care relationship with a local hospital and its Primary Care delivery partners. Another construct is a combination of Telemedicine and a type of visiting nurse relationship with scheduled hours. There are companies engaged in this field that are promoting these applications.
- Go to an On-Site Employer Owned or Sponsored Primary Care Clinic, which is the direction that many major corporations have taken and indicated that they will continue to take in the future. Learn about the vendors that are in these sectors, get conversant with their services and start a dialogue with your employers and their employees.
- Providing access to direct subsidized or no cost primary care services on-site can mitigate going strictly with high copays and out-of-pocket costs and simply transferring more costs to the employees. It has already been indicated that high-deductible plans have deteriorated primary health care access. Plus, there is a Growing Shortage of Primary Care Doctors!
I believe in this so strongly that providing financial assistance to create these health centers is the direction my new company will be engaged in. WE NEED PARTNERS!
Look Beyond Health Insurance Itself
With extended life expectancies, people will need to have savings income to go into retirement for 30 years, with key investments programs such as 401(k), Critical Illness Insurance, HSA’s with auto enrollment contribution, and collaboration with a local financial planning agency to deliver a savings and retirement package is a great combination.
Spending too much on health care means spending too little on financial protection planning!
George V. Duczak
Health Benefit Resources, Inc.
Contact Us Health Benefit Resources, Inc.
33 W. Higgins Rd.
South Barrington, IL 60010
Ph: (847) 551-5450