Choosing an Insurance Broker

If consumers can buy flights without travel agents and stocks without brokers, why must everyone buy health insurance through an agent model? For some people, the old model may no longer be relevant. If we want to lower healthcare costs, every stakeholder must help reduce waste across the system. That includes looking at whether insurance distribution itself can be made leaner, more flexible, and more aligned with consumer preferences. Not everyone wants or needs advice. Some are prepared to compare, decide, and buy directly. There is another uncomfortable reality. Most agents represent only one insurer. That means the advice a consumer receives is often limited to one company’s product shelf, even when a competing insurer may offer a better plan, better value, or a more suitable product. So we should be honest about what this model is and is not. It is not always impartial market-wide advice. In many cases, it is a distribution channel for a single company’s products. That does not mean agents have no role. Some consumers will still value explanation, reassurance, and support. But their value should come from genuine advice and service, not from preserving a cost layer by default for everyone. Reducing commissions alone will not solve healthcare inflation. The bigger drivers remain utilization, provider pricing, claims inflation, and system incentives. But if direct purchase can remove friction, reduce unnecessary costs, and give consumers more choice, it should be part of the solution. Lower healthcare costs will require many stakeholders to work together to reduce waste: patients making informed choices, providers reducing low-value care, insurers designing better incentives, and policymakers allowing more efficient models to emerge. Healthcare financing must evolve with consumer behaviour. If people can book flights directly and invest directly, it is reasonable to ask whether some should also be allowed to insure directly. The goal should not be to protect legacy distribution models. The goal should be to reduce waste, improve choice, and lower total system cost. #Healthcare #HealthInsurance #IntegratedShieldPlan #SingaporeHealthcare #HealthPolicy #HealthcareFinancing #Insurance #DigitalTransformation https://lnkd.in/g_fmUeHP

Rising health premiums. Less care. Worse outcomes. My guess is most of you are facing this right now. Here’s one approach that’s actually worked for us. A few years ago, Fireclay Tile hit a breaking point. Every renewal felt like a bad joke — higher premiums, fewer answers, and no real health outcomes to show for it. We realized health insurance companies weren’t going to make our people healthier. So we decided to take control. We built a new kind of wellness model — designed for real life, not fine print. We cut the premiums we offered our team in half. BUT, we then created a program where teammates could pay less than they were before by taking simple, proactive steps toward better health. This included: ✅ Annual Biometric screenings ✅ Annual Preventative care visits ✅ No Smoking Attestation ✅ Annual One-on-one “Benefits 1:1” sessions (Thank you Gaby Villanueva and Arianna Seyedjafari) And the results? In two years... - Biometric screenings ↑ 80% - Preventative care visits ↑ 78% - 90%+ Teammates completed “Benefits 1:1” sessions When people understand their benefits and feel ownership, they make better health decisions and should see improvement over the long term. But let’s zoom out. A recent New York Times article reports that employers are facing the sharpest increase in medical costs in 15 years — nearly 9% higher next year. https://lnkd.in/gbVgFue3 For Fireclay, this will be the fifth straight year of big hikes. And from what we are hearing, the numbers are shocking. And...we're not alone. All for what? Worse care? Worse outcomes? Let's face it. The system is broken. It's not designed to care. It’s designed to bill. If the health insurance system won’t make our people healthier, what will? For us, it’s trust, transparency, and aligned incentives. I do not know where it all goes from here, but what we do know is that we have to be proactive to support our team. 🧱 Healthier people. Healthier company. Stronger community.

Five phone calls, three stakeholders. No one accountable. That’s the reality of corporate health insurance when an employee is hospitalized. Read the full story below 👇 I saw this unfold firsthand during a recent hospital visit. A man sitting next to me in the waiting area was on his fifth phone call, not with his doctor, but with his insurance company. His wife was at the billing desk, filling out paperwork. And instead of focusing on his treatment, he was trying to get one simple answer: would his corporate health insurance cover the procedure? After 40 minutes, he hung up. This is what a “simple” health insurance claim looks like in most companies. The maze employees face: When an employee gets hospitalized, the process turns into a nightmare. The insurer tells them to call the TPA. The TPA asks for more documents. HR reaches out to the broker. The broker says it’s been “escalated.” Meanwhile, the hospital bill keeps climbing, and the employee just wants one answer: “Am I covered or not?” What most companies don’t realize: the real cost of health insurance isn’t the premium, it’s the erosion of trust when employees need help most. Why the traditional model fails: Traditional brokers excel at negotiating rates and closing policies. But once the policy goes live, their role becomes reactive. They step in when something breaks, but they’re not built to own the employee experience end-to-end. The result? Employees navigate between the insurer, TPA, broker, and HR. Multiple stakeholders. No single owner. And when frustration builds, it doesn’t land on the insurer or TPA. It lands squarely on HR. What a better approach looks like: One partner who becomes the single point of contact One team that coordinates with insurers and TPAs behind the scenes One team that stays involved from the first question to the final settlement So your employees never feel abandoned in their most vulnerable moments. #EmployeeBenefits #CorporateHealthInsurance #HRLeadership #InsuranceClaims #NovaBenefits

"There's a lot of money in healthcare, and there are a lot of players that do not want that disrupted. They do not want that to change, because who wants to make less money?" Josh Butler is refreshingly honest about what benefits advisors face when they challenge the status quo. Traditional brokers sell products. They represent carrier interests. They make more money keeping things exactly as they are, even when the system crushes the people it's supposed to serve. True benefits advisors serve as fiduciaries for employers. They put their clients' interests first. And here's the uncomfortable truth Josh admits: "I make less money with High Plains Health Plan than if I just sold Blue Cross Blue Shield." So why do it? Because being a problem solver beats being a salesman. Because building solutions for your community creates something that lasts. Because healthcare decisions have a greater impact on working families than almost anything else employers control. Josh's journey from traditional broker to healthcare architect shows what's possible when advisors embrace their true role. He started asking different questions. Not "which carrier can I sell?" but "what does this community actually need?" The answers led him to create High Plains Health Plan, a community-owned model that's delivering $0 deductibles while saving employers money. He's contracting directly with local surgery centers and pharmacies. He's bringing specialists to Amarillo instead of forcing people to drive hours for care. This work threatens established business models. Insurance companies warn that leaving traditional networks will be disastrous. Other brokers predict chaos. "It threatens their livelihoods," Josh acknowledges. "I certainly understand it." But the alternative is accepting a system where working families carry $8,000 deductibles they can't afford. Where employers watch healthcare costs devour every wage increase. Where communities see their healthcare dollars flow to distant corporate headquarters. The choice between comfortable complicity and meaningful change has never been clearer. Relocalizing Health with Dave Chase #BenefitsConsulting #Fiduciary #HealthcareTrust #EmployeeWellbeing #CommunityFirst

“We don’t pay our broker. The carrier does.” That sentence has cost some employers more than any fee ever would. A regional employer I met had a long‑time broker relationship: No explicit fees Annual renewal lunch Occasional wellness webinar Every year: A spreadsheet of renewal options that looked suspiciously similar A story about “medical inflation” Maybe a narrow network or wellness program thrown in as a “strategy” Then a new CFO asked: “Show me all the ways this broker gets paid.” When they dug into it, they found: Standard commissions buried in premiums Year‑end bonuses for hitting premium volume targets Extra dollars for placing business with specific carriers The broker was not just an advisor. They were a distribution channel with incentives that pulled against the employer’s goals. At the household level, it looked like: Employees absorbing higher premiums and deductibles each year Families changing doctors because of carrier swaps Confusion and frustration every open enrollment On the employer’s P&L, it looked like: Six‑figure overpayment versus what they could have achieved with an aligned, transparent model No real alternative strategies being brought to the table (self‑funding, DPC, transparent PBMs, etc.) When they switched to a broker who: Put all compensation in writing Carved out carrier bonuses and overrides Tied part of their pay to actual cost and quality outcomes …they didn’t just cut fees. They unlocked strategies their old broker never had a financial reason to recommend. The broker was never truly “free.” The bill just showed up in employee paychecks, skipped appointments, and your renewal line.

“I’ve been firing benefits brokers every 3 years for 20 years”. That’s what a CEO with 8,000 employees told me last week. He flips from one legacy broker to another expecting different results each time, but his conclusion was clear: “you can’t trust them.” It’s not the brokerage industry’s fault: the industry was created to serve as retail distribution for health insurers — and by proxy — hospitals and drug makers. However, since most employers have little to no technical expertise in healthcare finance or procurement, they are desperate for unbiased professional advice on how to maximize benefits investments. Here’s the thing: employers want advisory services, but the brokerage industry sells products. These value propositions are worlds apart, and the disconnect between what employers need and what the legacy brokerage industry was designed to deliver are completely out of sync. Why? Since brokers get paid by the same suppliers employers expect them to negotiate against, brokers make more money when the employer’s costs go up — not down. This is the ultimate fox/henhouse dynamic that paves the way for $300 billion in annual healthcare waste. That’s $4,000 per employee, per year. Here’s how it tactically plays out in real life: the employer is hungry for better healthcare options, but their broker only shows them 2 or 3 options each year. Guys: for mid-market employers, their are literally dozens of bundled healthcare solutions to choose from. Increased supply creates competition and reduces costs. It’s ECON 101, but if you can’t capitalize on this competition when your broker keeps it hidden from you. This is why the federal government requires employers to get unbiased professional advice. It’s so vital that it’s the second step in healthcare transformation (after establishing governance). Want better results for your business? Send me a message.

This article nails something most employers feel every renewal but rarely say out loud: We are staring down a full-blown affordability crisis inside employer health plans. Not “out there” in Washington. Not “over there” on the exchange. Right here on your balance sheet and in your employees’ paychecks. And yet… every year, most employers do the exact same thing: Call the same broker See the same spreadsheet Choose between the same 3–5 big carriers Move a few coins around the same broken game board Then act surprised when the result is: Higher costs for you, higher deductibles for them, and worse access for everyone. That’s not a strategy. That’s inertia dressed up as due diligence. Here’s the uncomfortable truth: If you keep asking the same brokers to shop the same carriers on the same spreadsheet, you will keep getting the same results—only more expensive and more painful every year. But this is not the only way to do health benefits. There are employers today who are: Bending their cost trend down, not just “keeping increases in the single digits” Improving access and quality while lowering out-of-pocket costs for employees Paying providers based on value and outcomes, not unit prices and mystery bills Using data, direct contracts, transparent PBMs, and advanced primary care to fundamentally change the financial trajectory of their plans What’s the difference? They stopped asking, “Which carrier should we use?” And started asking, “Which advisor is willing to blow up the old playbook and bring us radically different solutions?” If your advisor’s idea of innovation is: Another fully insured quote A Level Funded or Self Funded plan still with the large carriers A slightly tweaked HSA plan A wellness portal and a step challenge An ICHRA …you don’t have a strategy problem, you have an advisor problem. Employers: your health plan is likely your second or third largest spend. It is absolutely within your control to demand: Line-item transparency Aligned incentives Measurable clinical and financial outcomes But you will not get there by repeating the same RFP ritual with the same cast of characters. If you’re ready to explore models that actually change the trajectory for both your company and your employees, start by changing who’s sitting at the table. Stop asking, “What will premiums go up by this year?” Start asking, “Why are we playing a game that guarantees they do?” And if your current broker can’t answer that… it might be time to find one who can. Emma Fox, CHVA Adam Zebian Al Lewis 🇺🇦 Dave Chase Nelson Griswold Randall Schroeder Bill Miller https://lnkd.in/eZHcNBd2

If you're calling three different Employee Benefits brokers to find the best rate on your company's fully insured health plan, I have some news for you: the price is the same no matter who you call. Here's why. Insurance carriers price fully insured health plans based on your employee census, which includes age, gender, and ZIP code. That data does not change depending on which broker submits it assuming it's the same census. As I tell my clients, "The carriers should be giving all the different brokers the same price, because an individual carrier is not going to give broker A one price and broker B a different price. The census is the census." So if the price is identical regardless of who shops it, where does the real value come from? It comes from what your broker does beyond the quote. The brokers worth partnering with are the ones bringing creative strategies to the table: alternative funding, level funding, captive arrangements, and year-round support that actually impacts your bottom line. They are not just showing up at renewal time. They are working with you throughout the year, helping your employees understand their benefits, resolving claims disputes, and reducing the administrative burden on your HR team. The myth that one broker can out-negotiate another on a fully insured plan simply does not hold up. What does hold up is the quality of service, strategy, and partnership your broker delivers every single day. If your current broker is not doing that, you have more options than you might think.

Health plans are buying TPAs. That should tell you everything about what employers actually want. For decades, health plans have sold vertical integration as the solution. One-stop-shop. Seamless coordination. Better outcomes through consolidated care. Except employers are leaving that model in droves. Why? Because TPAs offer something health plans won't: true customization. With a TPA, employers can handpick dozens of solutions that solve their specific challenges. Want a different PBM? Here are 6 options, or bring your own. Unhappy with your network? Choose from multiple options. Tired of paying for bundled point solutions nobody uses? Cut them out and only pay for what you need. The best part? TPAs administer it all as if it's a single offering, making it seamless for employees. Employers can even customize the PBM itself by pulling the best, most transparent solutions across specialty, brand, generics, and mail order. No forced bundling. No hidden fees. Just the solutions that actually work for their population. This isn't theoretical. The model already exists. Hundreds of TPAs are doing this right now. And employers are figuring it out. Which is exactly why health plans continue to purchase TPAs. The real question: What can health plans learn from TPAs to fix their own business model before more employers walk away?

Most employers have no idea their broker is structuring their health plan in a way that benefits the insurance company more than them. That’s not an accident. It’s how the system is designed. There are eleven ways to finance a health plan. The typical broker shows you two. And the one they recommend usually isn’t the one that saves you the most money. The companies that are winning at this aren’t just picking a better plan. They’re attacking the problem from three angles at once: the right financial structure, removing the waste that’s quietly draining the budget, and using those savings to actually improve what employees receive. Better benefits and lower costs aren’t opposites. For most employers, they’re both sitting inside a plan that’s never been properly optimized.