SNN RETHINK Conference: Rethinking Health Insurance: Turning Health Insurance From Expense into Attracting Staffing

This article is sponsored by the Evergreen Benefits Group. This article is based on a Skilled Nursing News discussion with Shabsai S. Shuchatowitz, CEO of the Evergreen Benefits Group. The discussion took place on September 1, 2022 during the Skilled Nursing News RETHINK Conference in Chicago. The article below has been edited for length and clarity.

Skilled Nursing News: Tell us a little bit more about yourself and the company.

Shabsai Shuchatowitz: I’m Shabsai Shuchatowitz from Evergreen Benefits Group and Employee Benefits Consulting Group. We’re based right here in Chicago. At Evergreen, we develop innovative solutions to manage employee benefits far more efficiently than we see today. This translates into significant savings for our clients, their employees, and their families that we care for.

SNN: As the title of our conversation implies, there are some challenges that employers are facing today in the insurance market. What are some of those challenges and how are you working to solve them?

Shuchatowitz: Staffing is one of the biggest challenges today. Turnover today is one of the highest that we’ve ever seen. Employee benefits is a key component of what employers use not only for compliance, but to be able to attract and retain valuable talent and staffing. After payroll, employee benefits are one of the largest costs today. For many companies, it’s their second largest expense.

One of the main reasons for this is the ballooning cost of healthcare and health insurance. With more money going towards employee benefits, this continues to leave less and less money for hiring, staffing, and retaining valuable staff and talent. Legacy brokers often advise cost shifting, minimizing benefits, or other solutions without expanding them to try to shift the cost and minimize the impact for the employers. This often affects employees as well with higher deductibles, co-pays, co-insurance, or minimizing their coverage.

This could often mean that employees even with health insurance have a hard time using it. They’re virtually unable to use it as they’re on the hook for the first couple of thousands of dollars in care. Many of them simply avoid the care, or don’t seek the care that they actually need.

Kaiser News recently said over a hundred million Americans have some form of medical debt and the vast majority of those actually have health insurance. It’s challenging for everyone today. It seems that just every year you pay more and we just get less and less. It’s very challenging.

SNN: Based on what you know and see, what are some of the underlying drivers of those costs that are going up in terms of health insurance?

Shuchatowitz: Overall, the conventional wisdom is that health care is an uncontrollable cost. It’s going to continue going up year after year. Forward thinking consultants coined the big lie that insurers have duped Americans and even executives into believing that there’s nothing you can do about it. It’s going to continue to go up. It’s going to be five to 20% and now 20 to 40% annually. It is what it is. You can’t do anything about it.

We don’t believe it, and we have the information and data to prove it. If you follow the money, you really see the answers. All you have to look at is United Healthcare, we’re seeing the stock rise. They are each up roughly 100%, 10 times over the last decade or so. What to us is an expense, to them is revenue. What to us is cost, to them is profit. Their vested interest is for health insurance and health care to continue to rise on a permanent basis.

They do not have any direct interest in driving down the cost of our care. Therefore, essentially, they’re extracting value and they’re not providing that. They don’t have any direct interest in driving down that cost of care or really improving your direct health care. Secondly, hospitals today, whether they’re for profit or not for profit, have really turned into massive profit centers, 27 cents on the dollar of what we pay hospitals today goes towards doctors and nurses.

Twenty seven cents of what we pay toward hospitals goes to the actual care providers. The vast majority of it goes to overhead, administrators, staff, and profit. When that all adds up, those costs continue to have to increase. Lastly, I would say the model today for most health care is actually what I call ‘sick care’. The vast majority of the reimbursement structure today for most hospitals and health care providers is a fee for service.

Their vested interest is for continued focus on sick care, treatments, testing, medicating, and surgeries for different conditions without a focus on the health care and the preventative side of it. Essentially, hospitals and insurance carriers are really what’s driving the increased cost across the board.

SNN: What can be done to solve it on the end of the people who are facing those elevated costs?

Shuchatowitz: This is what we deal with every day. I’ll just touch on five specific points that come from the Health Rosetta and based on our acronym of LOCAL. The first step is L, learn how to escape the status quo. Stop accepting the new normal, the normal of 5 to 20%, or now it’s 20 to 40% cost increases annually and take that sitting down. There are solutions today, demand a better ROI, a better plan, a better solution. They exist and we’re proving it every day.

Second is O, optimize. Optimize your health plan infrastructure. Utilize a transparent financially-aligned benefit advisor that sits on the same side of the table as you, and will bring you transparent partners and vendors that are focused on providing solutions-based, providing transparent data, solutions-driven and measurable results.

The third is C, carve out the PBM (Pharmacy Benefit Manager). PBMs today are these middle men that supposedly are there to help you and save money in a pharmacy. They’re actually the largest driver in cost in medication today. They are so big that they’ve actually bought insurance companies and bought out insurance companies. That’s how much money they’re making in the middle.

Forty, or sometimes 50% of health care costs are going to specialty medications and these pharmacy benefit managers. By utilizing fiduciary, transparent, and honest PBMs, it saves a tremendous amount of money for both employees and the cost of them and their medications, as well as on the employers and their health care plan.

A is for adding value based primary care. Primary care, the concept behind bringing it back is to focus on primary care again. What is Direct Primary Care or DPCs? Think of it as a health care membership where you have a doctor, you’re paying a membership fee on a monthly basis where your employer is essentially through the healthcare plan and has unlimited care at no cost whatsoever to the employee, unlimited care, direct access to your doctor, or NP, 24/7.

It makes that access to care super easy for employees to be able to access. You don’t have to wait three months for an appointment. You can typically get an appointment within 24 hours. You can talk to them directly. They’re available there for you. It increases the quality of care, the access to care, the ease of care. It’s that delta that makes a tremendous difference, not only for employees, but for their employers. Many of you today actually offer this for even your residents in your facilities.

You have direct providers, you have doctors and NPs that come around and they provide the care for your residents. You have to provide a higher level of direct care, keep them at your facility so that they don’t have to get hospitalized, and keep them on your census. It’s the same thing for your employees. When they want to be able to have direct access to care, whether it’s onsite of your facility or nearby, it also keeps your employees from taking unnecessary time off and it keeps them on your staff and at work.

The last one, which is L, to leave the large PPO networks behind. Focus on providing easy and free access to care for your members, for your employees through a nurse concierge, and they can be guided to high quality, low cost providers. Each one of these can drive savings to your planning employees.

SNN: You mentioned that it’s possible to provide care at no cost to employees. Can you talk about some of the creative solutions that you’ve helped implement?

Shuchatowitz: There’s many of them, but I’ll just touch on three of them. During COVID, Americans finally realized that a lot of our care and discussions about health care and even diagnosis and treatments of care can be done virtually and via telehealth. 70% of low acute illnesses today can be treated via telehealth, via virtual care video, AI, taxes, all kinds of solutions today.

Providing that directly to your employees and expanding that at no cost to them whatsoever, unlimited, direct access to care. It’s a game changer. People get sick on nights and weekends and doctors are hard to reach. Appointments can be days to be able to receive, and sometimes people just, they need a question, they want to ask their doctor. That virtual care and that media access through telehealth, through an app on their phone is a game changer for employees. Many even offer this for your residence as well.

Offering virtual care is the same type of care that is available directly for employees on their phone and their app. Dealing with many of their ongoing chronic conditions, diabetes, hypertension, it doesn’t always require an in-person office visit.

A lot of that could be done virtually. It could be done on the phone or video, and by doing so it saves not only the employees, their deductibles, or copays or coinsurance, but it gives them direct access to easier care and it’s a win for both employers and employees. Second is care navigation or care concierge. Health care is complex today, even for those that are knowledgeable in the health care world comparing costs today for health care or getting quality metrics scores and actual health care providers and comparing the two are virtually nonexistent.

We call a basket of referrals for a specialist down the hall to be able to get additional testing and drive additional profit to the hospital or center. Independent care navigators can provide high quality independent nurses that provide independent information and cutting-edge technology. They have access to cost comparison. They have access to quality metrics on providers, and you can actually further incentivize it for your employees by plan design that they can get any care received through any of the vendors that their concierge suggests at no cost to them.

We call this a disappearing deductible. We want the deductible to go the way of RadioShack for most employees. Focus on care, focus on making it easier to care. It may sound counterintuitive, providing a higher level of care, easier access to care, the cost actually goes down. The last one is Direct Primary Care or DPC that I mentioned, which is really a movement that’s getting traction in the medical field. Most doctors say, unfortunately, they’re burnt out.

They see patients for 10 to 15 minutes. They’re spending 40% or 50% of their time doing insurance charting, and they’re not really practicing medicine. DPC liberates them to be able to actually spend three to five times the amount of time with you, spending time with a lot less patients. They can focus on medicine and focus on keeping you from going to other specialists, MER on other things.

By doing so, it provides a far greater value to employees. It saves significant money to the employees and the plan. It costs them nothing, and guess what? It turns that care into such a benefit and attraction that you as the employer, by an extension, not only in saving money in doing so, you look like a Rockstar. You don’t have a 5,000 deductible anymore. You have direct unlimited care at no cost whatsoever to employees and their families, and it’s a lot easier to retain that employee when they don’t want to walk away from that benefit of that employer.

SNN: Do you have any real-life stories you can share about how this plays out on the ground?

Shuchatowitz: We had an employee with severe diabetes and obesity, which is, unfortunately, very common in our population, and the SNF space, which led to clotting and circulation issues in her legs until her doctor said she had to have one leg amputated. She called a nurse concierge for a second medical opinion. She was directed to a high-quality local specialist within 24 hours, who after assessing her, was able to perform an in-office small procedure, changed some of her medications, provided specialized orthotics for her, and was able to save her leg. Two weeks later, she was back on both feet at work.

They also set her up with a health coach to be able to help her over the next following six months with nutrition and weight management. She was able to significantly save additional weight, which really is a game changer for her. This may have saved the employer tens of thousands of dollars. Think of the game changer that this had in the employee’s life and their family.

Second is something that comes up all the time, neuro placements. An employee had a neuro placement done by a general surgeon and placed in the standard two to three days. They ended up in the hospital for two to three weeks instead of six weeks for PT. They ended up over six-plus months with PT.

Through a whole ordeal, they realized, “Hey, maybe they should have gotten a knee specialist or gotten a different provider.” The next time around, a couple of years later, they called the nurse concierge, they got a knee specialist and the outpatient specialized surgery center, the bundled surgery contract. It saved the employer tens of thousands of dollars. She was back on her feet before she knew it. It was like my inundated two experiences for her.

Lastly, I would just say, even on the small things. Every day, almost once a week, we get questions about, “I need to get some imaging, MRIs, CT scans, X-rays, where do I go? How can I save money? What’s it going to cost me? I don’t have a price line or Orbis to be able to compare that yet,” we would like it to be available, “How could I go and save money on that? What could I do?”

The answer we tell them is, and we guide them through this, is that an X-ray, a CT scan, an MRI is the exact same thing at a hospital or an outpatient clinic, imaging center. At a hospital, a PET scan MRI can cost you $8,000, $9,000. An independent imaging center can cost you 10%, 20%, or $1,000. X-rays could be $2,500 or $250. It’s the same X-ray, it depends where you get it. This is where we guide them to how you actually could save money in healthcare.

SNN: Any last thoughts, key takeaways for the audience today?

Shuchatowitz: I just want to give you one specific example for an employer then my takeaway. That is, just yesterday we sent the renewal to our client of ours with a number of small facilities mostly based here in Illinois. They were partially self-funded, partially fully insured, and looking at a 20% to 25% cost increase. This is, unfortunately, the new normal. BlueCross, United, and all the carriers will tell you that’s what to be expected. We turned this around for them with a 30% decrease, not off the renewal, off of their current plan.

What if I asked you Mr. CEO, Ms. CEO, if I cut you a check for $1 million today, what would that do for you? What would that do for your business? What would that do for the growth of your business? What would that do for staffing, employee culture, reinvesting in your business, and growing your business, not just through acquisitions, but reinvesting in your employees that could provide a higher value of care?

What about investing in your employees providing that care, nurse concierge, no-cost medical care? You can make that difference as the employer. You are more powerful in that regard than hospitals, insurers, and in some ways, even the U.S. government. Changing the industry, changing a culture it’s in your hands. The power is there for you to do it. You could do it. All you have to do is step up and ask.

The Evergreen Group works with your company to find innovative solutions, manage your benefits plans efficiently, and educate your employees on many benefits options available. To learn more, visit: https://evergreenbenefitsgroup.com/.

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