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Mar 11, 2017

Where were you on March 23, 2010? Let me ask it another way. Where were you when the ACA was signed? That’s right, we’re just a couple weeks away from the 7th anniversary of the Affordable Care Act. 

  • During the first couple anniversaries, most brokers held their breath, hoping it would be found illegal (um, it wasn’t).
  • The next 2-3 anniversaries were the most disruptive to brokers. Remember when it seemed like every week the government would announce some plan design or compliance detail? It was the main headline and topic of conversation with every client that week. UGH!
  • The past couple anniversaries were better. The rules were getting settled, but upheaval continued in helping clients figure out how to actually follow the new compliance rules. Many brokers had good sideline consulting services to teach ACA Reform.

But, WOW – Anniversary #7 has us back on the Reform Roller Coaster again! All over the country I’m hearing how our industry is back to reading headlines. 

I'm sharing THREE trends, and ONE strategy and a solution to help you ride the roller coaster safely!

Trend #1: There’s a lot we DON'T know

What will plan design requirements be in 2-3 years? We don’t know. Will there be more or fewer carriers? We don’t know. What will the compliance rules require of employers? We don’t know.

Trend #2: There’s a lot we DO know

As we move away from the ACA’s “command-and-control” philosophy, we move toward a “freedom-of-choice” philosophy. The high-level description from President Trump and the GOP is that it will entail a few less coverage mandates, a few less compliance rules about employer reporting, and a few more options on plan design.

The 2017 Medical Plan Trends & Observation Report cites a 6% rate increase again this year.

The result for your client is that out-of-pocket costs will rise every year for the next decade. Sometimes it will play out with the obvious higher copay, coinsurance, deductible or out-of-pocket maximum. It can also come out it in other plan designs, such as longer prescription non-formulary / exclusion listssmaller networks, etc. 

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Trend #3: As an industry, we suck at Consumerism

The latest Alegeus Healthcare Consumerism Index confirms what we all know: our industry has not had much success empowering Americans to be better healthcare consumers.

Let’s be honest. Most brokers never made it their business to really teach employees. Oh, many brokers would mention it, but wouldn’t install real programs. Most just left clients to whatever tools the carriers included alongside their plan: 

• a telehealth program (ignored by 98% of people because it’s not promoted and carries a high consult fee)

• a nurse line (ignored by most, because they solved limited issues)

• a price-transparency tool (that nobody can figure out, and is only helpful with general pricing questions)

This was fine while the average American’s out-of-pocket risk wasn’t too high. But we are at a tipping point. You can no longer leave clients to whatever tools the carriers include alongside their plan. Medical plans will no longer be viable without consumerism tools that actually get used.   

And let’s level-set on terminology. Many brokers think of “Consumerism” only in relation to HSA Plans. Realize that if your focus is self-funded business, the word “Consumerism” is the same as “Employee Empowerment” and “Cost Containment.” 

The Strategy and a Solution

Now that we’re clear on the trends, here’s a strategy you might consider to help you and your clients ride out this healthcare roller coaster as comfortably as possible. 

Be a Consumerism leader! Both reports referenced above pointed at hope. The MPTO Report summarized:

“Organizations are looking beyond cost-sharing, to optimizing how they deliver health coverage and how employees access health care in order to control health care costs in the long run.”

The Consumer Index stated:

“We did see some improvement in pre-purchase behavior, with a 20% increase in consumers that report doing research and comparing alternatives before a major service or procedure.”

And I completely agree with their conclusion:

“It’s clear that consumers will need significant education, tools and support as they assume more financial responsibility for healthcare costs. It is up to industry leaders to empower the modern healthcare consumer…”

I suggest you become that industry leader. Be the broker who brings helpful tools that get used, thereby empowering the workforce of every employer in your care. Think about it as your next topic of consulting. What employer doesn’t want that?

“Great! Now what?” you say. This is the solution part. When ACA was ramping up 8 years ago, we saw the need for consumerism programs that would get used. We saw lots of the building block pieces… but they were barely introduced to employees with little to no promotion. So we sourced the best solutions we could find, rolled them together into a sensible bundle, and wrapped it in a turnkey member engagement program. These services empower members to make better choices, such as:

  • Telehealth services (with $0 consult fee) for phone/video primary care visits.
  • Doctors Online (also with $0 consult fee) for online consults with all types of specialists. 
  • Advocacy support to navigate the complexity of quality/price transparency and medical bills.
  • Rx Savings to bring alternative pricing for excluded or high-cost drugs.

NOTE! This is not me pitching my product, but rather it’s me explaining that we built our company for this exact moment in time. It’s not about the product, it’s about implementing solutions that help your clients become better consumers and navigate the industry at a time when there are more out-of-pocket costs than ever.

With all the upheaval in the market, this is the time to focus your prospects and clients on solutions that will help them, rather than on all the unknown. As you install real consumer-focused solutions, you’ll have a much more educated client base…right in time for the next round of inevitable reform changes. It’ll make a future transition much smoother than the last time!

Now it's your turn! How are you leading clients to implement consumer-driven tools and educate employees to use them? Leave a comment below or email me at


Reid has a passion for helping brokers & employers strategize fresh approaches to benefit plans that contain costs and increase access to care - helping employers & employees control their healthcare dime, time, and peace of mind. He writes & speaks around the country and is the Co-Founder & CEO of freshbenies.

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Tanya Boyd
Tanya Boyd
President of Tanya Boyd & Associates

I didn’t want to go to urgent care or the ER. Using Doctors Online in my freshbenies membership, I went online to ask a doctor. The doctor responded and said to check my blood pressure. He followed up with the next day to make sure my numbers were OK. By then, the feeling was starting to go away. He told me if it persists to contact my doctor. It was great that I didn’t have to go somewhere and wait forever, and it was free.” - Kelli from Texas

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