Emma Fox is Partner and COO of E-Powered Benefits. Her firm helps employers throughout the US customize health plans using alternative healthcare models that are capable of significantly enhancing benefits for members while at the same time lowering the cost by 20-40% (or more). The key is increasing awareness and resetting customer expectations through education. The current fee-for-service delivery system ensures a misalignment between plan sponsors/members and all other stakeholders. An informed consumer is capable of breaking status quo results. That’s why Emma helped create the Certified Health Value Advisor education module for employers and consultants.
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Benefits With Friends – Season 2 Episode 5 With Our Guest Emma FoxIt is Thursday afternoon here in New York. This is like déjà vu, full transparency. That’s what we are all about in this industry now. We had a technical glitch. We didn’t go live. Emma, who I’m bringing right into the show, we have been talking for the last twenty minutes. This is not Hollywood, Emma. I’m sorry. This is what happens when you agree to go on Boo’s show. I may have given all my best insights already. I hope I can remember them. Thank you, guys, for joining us. Hopefully, there are still people out there. I apologize for the technical glitch. Not my fault. I don’t own LinkedIn, although I’m thinking about it. I’d been watching this stock a little bit, maybe I could afford one stock. Dale Sagen said, “Whoops.”. He was a past guest. Emma Fox, for those of you who are not familiar with Emma, I’m going to read her bio again. I’m perfect at it now. Emma is the COO, Chief Operating Officer, and Partner at E-Powered Benefits, a benefits consulting firm designed to deliver high-performance health plans while staying committed to industry-wide transparency, which we are going to talk about in a bit. Emma also is a creator of virtual Coffee Break. Is that a Zoom or LinkedIn Live show? I’m old school. I don’t know how to do the LinkedIn live. I just do Zoom. When it works, it’s easy. Anyway, coffee breaks have been great for the industry. I’m sure you have a big following there. Those virtual meetings morphed into a huge party. YOU, where were we in, Phoenix? In Phoenix. It was a wonderful, great blast. Probably the talk of the industry functions was a big celebration but also a huge collaboration. Some of the best minds in healthcare and insurance. Employers benefit decision makers were there. One of the more challenging and impressive things that Emma helped create was the Certified Health Value Advisor Course, which is available to benefit consultants and also employers now. You take that as super valuable. I did that while I was in Phoenix, I believe. I was impressed. It was about three hours. It’s a five-hour certification, and there’s still stuff that could still go into it. It’s a long one. It was such a blast. It only felt like three hours. The parts where you did the speaking and the educating went by so fast. There was another person up there, I don’t remember who he was. They dragged on. I’m kidding. It was a lot of fun. There’s going to be another one in February where I will be in attendance. That one is in Miami. Who wants to go to Miami in February? That’s terrible. I have my hotel, my flight, and everything booked, and I’m already packed. Emma and I have known each other for a little while. We’ve met a few times at different conferences. She has a pretty big following in the industry. You or we need to get a better message out to employers. We are trying to help employers with all of their benefits but it is so focused on the employer-sponsored health plans that have spiraled out of control, both from a premium cost standpoint and also from an out-of-pocket cost standpoint. The thing that resonates the most with me and motivates me is that the type of plans that managed care has evolved into from $2 copays back in the early ’90s up to $17,000 out-of-pocket on many plans and even HSAs with significant first dollar out-of-pocket cost. It can’t stand, not with what I’ve known and I’m sure what you’ve known about what’s happening behind the scenes with healthcare and health insurance. I’m going to stop there for a second. I’m going to turn it over to Emma. Let her introduce herself a little bit more if there’s anything I missed, and then we will get to the conversation. Thank you for having me on. I did already say this but it’s a relief to have something other than fourth-quarter madness to do for an hour. We all feel the same way. The people who follow me and those that I follow are all fighting the same fight. Many people know that I used to work at a carrier. I was at carriers for much of my career. There came a point where it became too hard to get up in the morning and do what you needed to do, regardless of how important it was to do a good job. I don’t do it anymore. In fact, I try to do the opposite most of the time. My job has morphed a lot more into creating comradery, education, connecting people, getting brothers and sisters to stop fighting with each other and realizing we are not each other’s enemies. We might be doing the same work. We might even have the same job title but we are not fighting against each other, and we’re fighting something much bigger. That’s what I try to do with most of my career these days. It has been incredibly rewarding. The collaboration is something. Ryan Miller is a personal coach and business coach. He released a short clip from the taping that he and I did a few months ago, and I mentioned on there that this is my 30th year in the business. Several years ago, I changed the trajectory, and in the first 25 years of my career, I did not make one industry friend. I had people I was friendly with but I didn’t share information with them. I didn’t share information with my general agent comrades or other brokers. I worked with brokers and helped them provide benefits. I thought, “These are all my secrets. These are all my strategies, and this is how I get the lowest renewal and the best rate.” Years ago, when I saw under the hood of health insurance and healthcare the true prices versus what we are all paying, I got upset. I felt alone, and I had to make a decision, “Am I going to go back to the way I’m doing it, knowing the impact it was taking on the members, the employees, and the employers that I was serving, or was I going to try to figure this out?” In the beginning, I was trying to figure a lot of things out myself. A lot of it you covered in the course, the Certified Health Advisor Course. I started because I was searching for information. I came across other advisors in Texas, California, Carolinas, and Florida. We are on the same trajectory. We were all in little rowboats in the middle of the Atlantic Ocean, and none of us knew where the shore was, and then we jumped on the same. Now it’s become pretty powerful. Still scratching the surface. There are way too many employers and members to serve with the number of people that we are now. The more shows like this and your Coffee Breaks get out there, it’s going to pick the curiosity of employers and other benefit decision-makers. They are certainly going to start slowly looking for alternatives. Pay more, get less is not an answer. It’s interesting when we end up talking to the majority of employers that we talk to have reached past the breaking point. The breaking point was a few years ago when they got their last crappy renewal and then persevered a couple more years where anything, even if it sounds like a gimmick, it’s too good to be true or that could never possibly work here in this state. They’ve gotten to a point where there is no other alternative. We’ve seen businesses in the last few years close their doors, and healthcare costs are a leading factor in people losing their livelihoods. I don’t want to get too much on my soapbox but that’s what we’re talking about here. If people that are in the healthcare system are often facing life or death, and if it’s not life or death, medically, it’s financial ruin in their personal life. On the employer side of things, people are closing down their businesses because they can’t afford to provide mandatory healthcare coverage for their employees, who are also going bankrupt. It’s an evil empire. That’s what it feels like. If it’s not life or death, medically, that people in the healthcare system often face, it's financial ruin in their personal life. Click To Tweet It doesn’t just feel that way. It really is. There are so many people who have been groomed by the managed care fee for service delivery system. I go back to. I was doing this, there was no managed care, no HMOs and no networks when I got in the business. We were selling indemnity plans, and companies like Chubb, Guardian, US Life and Home Life were the popular companies. These networks came out, and people were like, “What’s that?” The funny thing is when I think about change, and I will see if maybe I will play this video for us, the Enemies of Success. Change is a big part of it. Back then, people thought that the five 10% increases on indemnity plans were out of control, and managed care plans came out with these books, networks, and copays. No one knew what a copay was back then but the consumer made a choice like they chose Netflix over Blockbuster. The consumer said, “We like these plans. We love $ 5 and $2 copays.” We are willing to go through this disruption to educate our employees. We don’t like the $500 or $1,000 deductible and 80% co-insurance. Where’s that going to go in a couple of years? They jumped onboard and went through the pain of what that change was. People like me are lugging fifteen directories through New York City. Nothing was online back then. My back was in pretty good shape. Change seems more intimidating for some reason. The managed care plans are neck-deep. We have been groomed to think that we are getting the best prices and that the insurance carriers that we partner with are negotiating great discounts with the healthcare system. When you see the real prices, you understand that’s sadly not the case. It’s the opposite of the case. We are seeing the hospital transparency data, some who are complying are posting it, and if we can get it in a readable format, we are realizing that networks are your absolute worst choice financially. The problem is that the members, the patients, don’t get to make that choice. They don’t get to choose which carrier or contracted rate and don’t get to shop to figure out as they would with anything else. This has been an interesting point in my career the last few months, talking to a bunch of people about, “How are we going to use that data? It’s only good if you can do something with it.” We know now that networks make it worse. The cost is better when they are not involved. They are this behemoth. Someone asked me on stage, “Do I think the BUCAs are ever going to go away?” No, they are never going to go away. They have more money than sense, and most of us have sense but we can prove a point, which is that members have no choice at all in terms of what rate they are paying. They don’t get an opportunity to be consumers. That’s why HSAs haven’t worked. Great in theory but if they can’t shop, how can they get a price? I’m finding that there’s a lot of opportunity in this data for us to recreate some of those payment methodologies where we can make reference-based pricing a little less painful if it’s not based on Medicare. There’s a lot. In the next few years, we will see a substantial change using that information. One of the things that I’m noticing is that the healthcare system and the health insurance companies behind the scenes are at war with each other. The providers are becoming the insurers. The insurers are buying the providers, through my sense, I’m not in the boardrooms with them, but my sense is that they understand the consumer is becoming more informed. The carriers and the healthcare system are starting to change their lingo. They are starting to use terminology that means something. I don’t think that there’s a profound desire that they change their business practices but perception is reality. As long as they start using some transparent type of dialogue, they are going to get the benefit of the doubt. They realize some of the current profit centers, the artificial prices, and the hidden profits will dry up. They both have a fiduciary responsibility to try to maximize their profits. They can’t let it happen. They are going to create new profit centers, and that’s by jumping into each other’s shoes. They are mammoths. There’s not any fighting them. You can go around them. You can do something different but you can’t fight them. It’s like David and Goliath, in our case with our David. What you said, in the beginning was important, which is that we have several entities in our industry, both on the care side and the insurance side, that are at war with each other. If there’s anything I can impart to any audience ever, it’s that we are not each other’s enemy. We are truly not. If you ever talk to a doctor, tell me one time you’ve ever talked to a doctor who said, “I love insurance companies. I love working for this big hospital that makes me focus on production instead of the quality of care.” it doesn’t happen. It’s not doctors that are the problem. It’s not brokers who rightfully insured businesses or take commissions, and they are not the problem necessarily either. What needs to happen is that we all need to realize that we have been very effectively stuck in a system that’s much bigger than us and that has determined what our value is through our compensation. We don’t get any say in that. It’s BS. Where would this fly anywhere else? We need to figure out that working together is going to be a lot more effective for us to make change than us fighting and pointing fingers at each other. We all need to realize that we've been very effectively stuck in a system that's much bigger than us that has determined what our value is through our compensation. Click To Tweet That’s where collaboration comes into play. It speeds our education up. The deliverers of the new alternative universe of healthcare and health insurance that are possible out there. David asked about the BOO on my shirt, and I don’t bring it up on every show. Since he asked, we talked about it before we went live. The BOO, my real nickname is Bubba. I’m an identical twin, and my brother and I have been calling each other Bubba for years. A few years ago, during this whole path, I was working on my business card and said, “I don’t want to be a broker. I don’t want to be a consultant. I want to be an advisor.” I was reading an article in Benefit Advisor or HR Advisor Magazine about Benefit Optimization and, “Here are the 10 or 15 steps that all companies have to do to optimize their benefits.” I read it and said, “That’s amazing.” They hit some incredible points but there’s no way employers are going to be able to do it. They are not able to devote the amount of time that you and I both know it takes to raise their awareness. There are so many rocks to uncover and look under, and that’s what’s valuable about the course that you’ve created. BOO is Benefit Optimization Officer like an Outsource CFO. I like to think of myself as an Outsource Benefit Optimizer, and a lot of the advisors that I talk to see themselves that same way. It’s a differentiator. Dave, thank you for the question. Chris, thanks for sticking up for me there. I’m not going to play the video but before we went live, I showed you the video about The Enemies of Success. The three main ones were the Comfort Zone, Learned Helplessness, and The Path of Least Resistance. When I think about renewal time, most of the time we get our renewals for our clients 60 to 90 days prior. By law, that’s when they have to be released 90 days after you give your large group and 60 days for most small group businesses. It’s not enough time to do an analysis and educate a consumer, and the whole system knows this. Insurance carriers know we are going to release it when we release it. We don’t want the customer and the consultant or the benefited optimization officer to have the time to do all the due diligence, to have all the conversations that need to be taken place, and make changes. In essence, we are change-makers. For me, that has to happen outside of the normal cycle. When you renew your plan and finished open enrollment, it’s not time to close the book and wait nine months for the renewal to come out again. That’s the time to learn. For me, the renewal is not the start of the new plan year. The renewal is at the end of the last plan year. What did we learn from that renewal, and where can we make changes for the better to have more success next year? More success isn’t measured on, “Can we save money.” It’s, “Can help the people we are providing this valuable benefit to be healthier, lead healthier lives, and get the care that they need.” That’s where a lot of the data comes from that is available even in those small groups. You know as well as I do that there are a lot of technology and artificial intelligence companies where we can extract data for customers that are still doing it the fully short, old-fashioned way. Have you had any experience, personally, with them? Do you have any stories to tell if you did? I agree with everything you said. Change and comfort go hand in hand. You sat through the CHVA course. We have a good example there of how consumers are finding their way to doctors, and it’s Google. It’s like looking up a Yelp review, except the doctor is reviewed by other patients who have been there twelve different times for an injury that hasn’t been healed. That’s what we’ve given them. Even now, we will encounter members on our plans. We look up their surgeon, and they are not having good results. We say to them, “This surgeon is not good quality,” and they are so comfortable. You can present them on a piece of paper, “This is bad for you.” They will still do it. It’s almost akin to addiction at this point. You can’t put it down. You can’t look away. We have tons of databases, though. We have many smart, incredible people in this industry that are creating tools all day long. To your point and the video that we watched that I hope you will post somewhere else, most of the battle is being comfortable enough to try something different and trust that the data, the science, and the process are going to take care of you. A lot of people don’t have that level of bravery because they’ve always done what they’ve always done, and there’s a lot of comfort in that. It starts with the conversation. I always say, through this show, our website, and other venues, we want to share that there’s an alternative universe of solutions. It can’t hurt you to hear about them. Imagine what the impact can be doing it this other way. I expect that most of the time, people are going to go back to doing it the way they did it. In year two, they are going to be like, “Again?” In year three, and that’s when we find that we get most of our new clients after they’ve increased their awareness and realize, “This is hurting our company. Where are we going to be in five more years of this status quo?” I mentioned it on a bunch of the shows but it’s worth mentioning because it gives me goosebumps. My first experience with an independent third-party administrator, independent clinical case management company, and pharmacy benefit manager. I’m sitting in my office, and I’m sitting here. We had changed from a self-insured model. They were self-insured already but with an insurance carrier and maybe a week or two into the new plan year. We had finished open enrollment. I got an email from the clinical case manager, which I’d never had before. This is my first one, “Lou, here’s the scenario. This person is going to start this treatment, and we want to talk to them. Can you let the company, the HR manager, let this gentleman know?” First of all, they needed the name of the person because, to them. It was an ID number. They needed contact information and said, “Do you mind asking the HR manager or director to reach out to let them know that this is legit? This is a new part of their health insurance plan because they probably haven’t experienced this before.” To speed it up, what ended up happening was that a young man who was on disability with multiple sclerosis was about to start an injectable medication that was $115,000. It was twice a year, so $230,000. That’s a number. The number doesn’t faze me but it’s a medical claim. It’s going to be administered in the doctor’s office. It’s not a pharmacy benefit. This person has a $3,000 deductible and a $7,500 out-of-pocket. The old way, he would’ve had the injection, and three weeks later, my worst nightmare is that it changed his life for the better. He then gets the bill, and he gets the EOB confirming what the bill has already told him, “You owe $7,500,” and then he never gets it again. That quality of life that he experienced for 2 or 3 weeks is forever in the past or the alternative is that he does get it, and now we can never go on vacation with his family. It’s going to be $7,500 every year for the rest of his life. That, to me, is the alternative. What we did was we sourced it directly from a great company. They went to his home, delivered it, and it cost that member zero. It saved the employer $100,000. I say that last. For me, that’s the last thing. The savings is huge. That’s probably why a company does it at the end of the day and pushes them over the border to the finish line, at least to take this route. I don’t know if you have had any similar individual stories because it’s about the people. We deal with it every day. All of our health plans many, people know we don’t use networks. We are all open access. We lean heavily on direct contracts but we have to fall back on reference-based pricing. The benefit there, as full of friction as those plans can be, is that we have an opportunity. There’s a stopping point, a pause where we have an opportunity like you had to say, “We can maybe fix this before something bad happens.” When we can, it’s beautiful but it can be anything from sourcing medication, and it doesn’t have to be drastic in your example. That’s a beautiful example of something drastically improving someone’s financial situation. Many people can’t afford $1,000 or $500. People are breaking their pills in half or not filling their prescriptions. I look at data for our clients on a monthly and quarterly basis. Some of the better analytics platforms will tell me that people are adhering to their care plans. Most of the time there is no, and the biggest barrier isn’t access to care. Although sometimes that’s an issue. It’s the finances. It’s the money. It’s costing them an absolute fortune. We look to source medications. We look for bundled rates. Coral, I don’t know if anyone knows Coral but their team created this incredible marketplace where you can go shop for bundles that are guaranteed and save a ton of money. To your point, you can source medication internationally and domestically. The barrier we always have is convincing people that this is legit because it sounds too good to be true. They don’t believe that there’s another way to do this because there has never been another way, and their broker surely has never told them that there’s another way to do it. There are tons of opportunities, not a lot of access to those people. One way that I try to make people comfortable is say. This is everything that you have now. Everything that your insurance carrier and your healthcare system are delivering to you, plus the things that they should but won’t. They have a misaligned incentive to do it the way they are doing it. The reason why education is so important is until the customer starts demanding more and understanding that their expectations are way too low. I don’t fault a broker for selling insurance because that’s what the customer oftentimes is asking. They are selling what the consumer is asking. If the consumer doesn’t raise their awareness so that they can properly set expectations, they are not going to get delivered a better product. There’s fear. This is hard sometimes because we are trying to convince people that aren’t asking to be convinced. They want a better version of what they already have. I agree with you, though. I don’t begrudge any broker for selling fully insured products. There is a restriction, in fact. There are some places where there is no other option but to be strategic, smart, and intellectual about those products as best you can. Now, I’m going to date myself, it has been maybe a couple of decades since I got licensed. Do you remember getting your license? What did they teach you about? They taught you about fully insured products. That was all I learned to become licensed to be someone who sells benefits in insurance. That’s the only thing they taught me. When I came out of that environment, I had to forget everything that I had learned. I had to keep some stuff but I had to relearn a completely different way of purchasing and healthcare delivery. The average broker, I don’t even think I know anyone who comes out of school nowadays and says, “I want to be an insurance broker that looks fun.” They are getting licensed. That’s their first step, and they are learning exactly what the carriers want us to learn because that’s what they want us to sell. I hope that we are creating more educational pathways so that people can expand their knowledge. Of course, we are stuck. It’s no one’s fault. It’s not the broker’s fault at all. A lot of people last, the conference that I had. Everyone knows the E-Powered Benefits are fee-based. We don’t do health plan commissions. It broke my heart because we were coming to almost the launch date of the first symposium, and I got a call from a female broker, and she says, “I want to come to your conference but I don’t think I’m allowed because I take commission” and I was, “Of course, you are allowed. Everybody is allowed.” I was devastated, and I changed my message after that phone call earlier in 2022. I realized I wasn’t being clear enough. I don’t care how you get paid. I care about what value you are delivering for the paycheck that you are getting. A lot of us are stuck in a system, and many of us have already written a book of business. We can’t very well turn around and put it down and be like, “That’s our family’s income. We can’t start over.” Many of us are not that privileged. It’s going to be small. Before we went live, you said,” You have to do one little thing. One little thing here and there.” That goes for employers and brokers as well. I use this line a lot but the conversation is complex, and the solutions are simple. You couldn’t. Maybe you could. I couldn’t explain to you how my car starts. I couldn’t explain to you engineering and electricity and all of those things what happens. You don’t even put a key in anymore. When you push that button, what’s happening under the hood? We all know how to drive. You don’t need to know how something drives or works to operate it. You don’t need to understand every intricate part. That’s your job and my job of vetting the company’s understanding. We are trying to say, “Let’s go for a test drive.” By test drive, I don’t mean let’s try this for you and see if it works. “Let’s do an analysis. Let us show you the numbers that we talk about and capture those numbers. Share your renewal with us. Let us break it down and have a conversation that’s not going to be focused on the net premium increase. Let’s talk about what retention is, pooling charges, credibility, and all of these different factors.” I compared three renewals, January one renewals, all fully insured, large group, and not one of them from the same carrier had the same trend credibility factors, retention. When I started calculating the retention, it was shown as 17% but they did something very clever with the math. They took 0.17 and subtracted it from 1, which gave them 0.83, and they divided the number by 0.83, which was equivalent to a 20.4% retention. There are a lot of creative things when you break them down, and you get into the nooks and crannies that make our life fun. I love being able to sit down with an HR director and say, “First of all, have you seen this page of the renewal first? Have you seen this financial breakdown?” A lot of times, it’s no. “Let’s go through it. Do you have some alcohol, maybe we should do some shots.” It becomes a lot of fun. One of the encouraging things that I know we have to end soon about the YOU Powered Symposium in 2021, and there’s another one in February. We talked about that before the taping of the show. Look up the YOU Powered Symposium in February of 2023 in Miami. One of the real, super encouraging things for me, and I have been in this for 30 years. I still think I’m one of the young guys in the industry. There are people older than me. There were advisors that were in their 80s that I met there, and I’m wondering. “How hard must this be with the technology and everything?” There were people there that were looking to be advisors that weren’t even advisors. Twenty-something year old said that, “We are getting into the industry. Reminded me of myself,” and I said, “I want to leave this industry in better hands than it is now than it has been in the last ten years.” People like you and your courses and all of that hard work, digging, vetting, and taking the lumps, it’s not easy. Thank you for saying that. The YOU Powered Symposium was truly an impetuous decision, and it did come from the Coffee Breaks. I had a lot of people who used to say, “I wish we could do this in person” and I was like, “Why don’t we,” and my husband was like, “Don’t even,” and I had it all booked within my two weeks. Maybe a little compulsive? A little bit, yes, but it felt important to me. Unfortunately, I didn’t get to experience the conference as everyone else did. I was running around. What I did get to see were a lot of the stuff that was happening in the hallways and the conversations that people had. I saw two grown men cry at the YOU Powered Symposium in gratitude for the conversation that they had with each other. It opened up this platform where you could be anything. You could be at any part of your journey at the beginning, towards the end or in the middle. You could be refiguring it out, and it didn’t matter. Everyone was there to support and lend a hand, and I firmly believe that there is way more that I don’t know about this industry than I do. I know there’s someone out there like you or Chris Fischer or Mark Tesla who can help me. As smarter as those folks are, there’s some stuff I know that they don’t. Why wouldn’t we help each other be successful and help other people too? It sounds a little like Kumbaya. I believe in it, and it legitimately works. There is way more that you don't know about this industry, and there's someone out there who can help. Click To Tweet It’s how movements get started. It has to start somewhere with a dream. That’s the thing that’s amazing about it. There are many people on the same path and the pain that they are going in on a daily basis. When someone reaches out and says, “Can we talk? You’ve mentioned the company. I need to know who you’re working with.” I haven’t had one person that I’ve reached out to that says, “No, that’s my trade secret.” This hasn’t been one person that’s reached out to me that I haven’t. I will spend an hour with someone. This has been great. It’s even a little longer than expected. We had a little glitch but we got it done. Thank you so much. Enjoy Thanksgiving week. It’s my favorite week of the year. Hopefully, you won’t get the snow. It’s happening in Upstate New York. They are getting a blizzard, maybe 3 to 6 feet, I heard. My nephew’s up in SUNY Binghamton. I will keep my non-snowy, chilly weather but I don’t know. You don’t seem one for a whole lot of self-promotion. For anyone who’s watching, you should tell them that they need to go vote for you since you are on the award ballot for the YOU Powered Symposium in February, and a lot of other cool people are too. I’m looking forward to the outcome, and you are planning to come. I am very much looking forward to seeing you in February. I don’t think there’s anything wrong with being in Miami in February. No, not at all. I’m sure that it will snow here at home because that’s what typically happens, and I love that. I might even bring my better half with me. We will see. You should. Spouses are welcome. Let me know. Thank you so much. Have a great day. Thanks, Lou. Enjoy Thanksgiving. I will see you in February. You as well. Bye.
- Dale Sagen – Past Episode
- E-Powered Benefits
- Coffee Break
- YOU Powered Symposium
- Article – What is Benefit Optimization?