Jeff Marks discusses strategies for medical brokers to consider as health care reform is implemented. He believes brokers will need to expand their offerings beyond traditional insurance to include ancillary products that provide added value. Specifically, he recommends telemedicine services that allow clients 24/7 access to doctors by phone for diagnosis and treatment. Telemedicine could reduce costs for employers and employees while increasing productivity. Marks also suggests other non-insurance products like discount programs and lifestyle benefits that pay brokers commissions. To prepare, brokers should develop new business models incorporating these innovative ancillary options to differentiate themselves and generate additional revenue streams.

1. What Every Broker Needs to Consider <br />As Health Care Reform Rolls Out<br />Innovative Strategies to Serve your Clients,<br />Differentiate Yourself, and Generate Additional Revenue<br />By Jeff Marks, MPH, CWPM<br />Jeff Marks has extensive knowledge in the health and wellness industries. He earned his undergraduate degree at Emory University, his Masters in Public Health at Tulane University and is a Certified Wellness Program Manager.Mr. Marks has spent 30 years working with fitness centers, corporations, insurance companies and two Governors’ task forces developing new strategies to promote wellness and manage health care costs through a variety of approaches. He now represents one of the country’s largest benefit providers with a proprietary program called HealthPerx™.This innovative program can reduce absenteeism, increase productivity and provide many other needed benefits while supporting the primary workforce issues of the day—managing healthcare costs and promoting personal accountability.Furthermore, it fills in many gaps found in our evolving medical care plans and offers brokers unique strategies to help their clients and generate new revenue streams.Contact Information:Phone:(205) 222-4062Email: jmarks@hlperx.comWebsite:www.hlperx.comHealthcare Reform will bring with it many changes to the insurance industry, many of which have yet to be revealed. Some of us will wait to find out what those changes mean and how they will impact our way of doing business while others will plan their strategies now so they can be prepared for what they believe is about to happen.<br />According to many of the experts who closely follow the intended purposes of the bill, there are several scenarios that seem very likely to occur:<br />Government intervention will create significant restrictions in individual, group and self-funded plans.

2. Commissions will be reduced and in many cases eliminated both within and outside the exchanges

3. Brokers will be forced to expand their offerings into other ancillary product lines, many looking for innovative products that will create added value for their clients and generate new streams of revenue for themselvesWhat We Do and Don’t Know:<br />We know that every state will have exchanges. These exchanges will check for eligibility for subsidies, quote medical coverage and handle enrollment and billing. It is expected that there will be a limited number of medical plans within the exchange that will be similar in design. It is also expected that the application forms and billing will be standardized. Brokers can help their clients select the best plans in these exchanges but because so much of their work has already been done, their expertise won’t be as important and their commissions will more than likely be much less than they earn today.<br />What we don’t really know is how many people will use the exchanges. We know the bill set a national requirement that everyone at 133% of the Federal Poverty Level (FPL) will get Medicaid coverage, which will mean about 19% of the population. We also know there will be a sliding scale of 133%-400% of the FPL for government subsidies. That represents another 57% of the population. If the government requires those who receive subsidies to purchase their healthcare through the exchanges, that could have a severe impact on brokers’ revenue. On top of that, several Fortune 100 companies are already preparing to eliminate their current healthcare plans and pay their penalties, sending their employees to find their own solutions.<br />For those who are not eligible for subsidies and exempt from having their employers cover them, there will be a number of opportunities outside the exchanges. This might be your best target market. Keep in mind, though, that with new requirements for specific loss-ratio requirements, this could force carriers to reduce commissions.<br />What should medical brokers be doing? They certainly need to consider whether to work within the exchanges. It’s a time/reimbursement decision. They also need to look at specific target markets outside the exchange. But now, more than ever, they need to plan ahead and envision new business models that differentiate themselves from the “old school” brokers. They need to include ancillary products that can offer their clients value-added benefits that generate new income streams for their business.<br />Innovative Ancillary Products:<br />Traditionally, brokers have sold ancillary products like dental and vision insurance, critical illness, accident and disability. Many will continue to sell these in greater volume to more groups. One of the challenges, though, is employers have been reducing contributions to these products.<br />There may also be some new opportunities in voluntary benefits that become apparent as we see what the government will and will not pay for. One such opportunity may be pharmacy benefits.<br />Non-insurance, non-risk products:<br />With over 30 million consumers entering the system and an existing shortage of physicians, we all know physician clinics will be backed up. Walk-in clinics will begin to pop up in pharmacies and grocery stores to handle some of the demand. Most of us will see a nurse practitioner or physician’s assistant if we do make it to either.<br />One of the emerging access points for healthcare that is proving to be convenient, effective, affordable and very appealing to employers and employees is telehealth or telemedicine.<br />Using a telephone we can now access a network of board certified physicians who can diagnose and treat most minor health issues anytime, anywhere, 24/7. They maintain portable electronic health records allowing them to provide cross-coverage around the clock. These physicians can prescribe medications as appropriate (no controlled substances). <br />Studies are now showing 94% of those who call in are treated and diagnosed with a 98% satisfaction level. About 64% say by survey they would have gone to a physician’s office and 15% say they would have gone to the ER.<br />This ancillary product can save employees with high deductible plans thousands of dollars a year but more importantly, it can reduce absenteeism, increase productivity and decrease overall healthcare costs to the employer—a solution that can help brokers earn the medical sales book of business.<br />Many people are very skeptical about the quality of care and the legality of giving a diagnosis by phone. Over the past few years these issues have been dealt with and several million people have used these doctors. Telemedicine offers high quality services with physicians who have been screened, trained, credentialed and are continuously peer reviewed and they meet all legal, compliance and medical criteria.<br />It is my belief that every company in America in the years to come will require their employees to speak to a doctor by phone before they go to a clinic or ER and in so doing, companies will see significant savings to their bottom lines. If that is a possibility, why not be the “innovative” broker who introduces this solution before your competitor does?<br />Other ancillary products that can save the employee money and give the employer a sensible solution for some of the other benefits they need to carve out or de-fund: discount programs for pharmacy, vision, dental, hearing, and other health networks. Discount networks have been around for many years, but now they make sense. Because these are not insurance products and because they were designed to drive traffic to their network providers, they can be packaged inexpensively and offered to the entire family for one price.<br />An important point to keep in mind is they are still part of a regulated industry, so compliance with statutory requirements is important. Your best bet is to partner with the right company that has a turnkey program with products, enrollment, fulfillment, customer service, compliance and marketing so you don’t have to reinvent the wheel.<br />There are also lifestyle benefits that can be offered as ancillary benefits. Packages that include roadside assistance, identity theft protection, fitness club discounts, legal care direct and even pet care can be offered at very low rates to the employee.<br />These health and lifestyle ancillary products typically cost the employer or employee around $15-$20 per month respectively (larger groups get better pricing) and pay brokers generous commissions. The best part is these reimbursements will not be affected by healthcare reform because they are non-insurance products.<br />I believe you will find that your client companies will find great value in telemedicine and discount medical benefits because they will not only save them money but offer innovative solutions to complement their medical plan. Those employees or individuals who are the end users will be able to save thousands of dollars a year and have access to healthcare 24/7 (which really fits their lifestyle) as well as discounts on other health and lifestyle benefits.<br />What Should You Do Now?<br />Come up with your game plan for the future.