Complaining Is Easy, Winning Is Hard
There is a lot of noise in our industry right now and more frustration than ever before with traditional network solutions. Industry voices and publications are saying out loud what employers have felt for years: The traditional network health plan is too expensive, and it’s not working for plan sponsors or for families who have to pay the premiums.
Spend enough time on LinkedIn and you’ll spot the pattern:
- “The healthcare system is broken.”
- “The BUCAs are ripping us off.”
- “This is unsustainable; prices are out of control.”
- “How can they not let the plan sponsor review their claims?”
There’s an answer to all these complaints, so employers don’t have to be the punching bag. Even more, we know they want real solutions, not online echo-chamber banter.
I truly believe most of the so-called “experts” are way behind the human resources staffs that we work with in terms of knowledge. Either that or these experts are just complainers, whereas our clients tend to be operated by action-oriented problem solvers. Every time I see this outrage, I immediately wonder what the person is doing about it. I’m not talking about getting online and telling everyone how upset they are. What are they doing, in practice, to meaningfully reduce the spend for plan sponsors?
I’m not going to tell anyone to stop being outraged. You should be. But 95% of the time it just feels performative, because you get to the end of the message and they never tackle the hard question of what to do. I want to give them the contact information of one of our clients who can explain to these “experts” that plan sponsors are doing something about it and this victim mentality isn’t helping anyone.
Bias or Ignorance?
Everyone understands the fundamental element driving skyrocketing costs for plan sponsors is inflated prices. Network contracts take away almost all ability for a plan sponsor to defend themselves against unfair pricing, as well as the unchecked waste in their claims. So many conversations or posts lead to the obvious conclusion that the network model is the problem, and replacing it with reference-based pricing is the straightforward solution. But, inevitably, somehow these pundits can’t get themselves to say it. Maybe they have ulterior motives and are biased due to financial incentives. Maybe they really don’t know or understand RBP. Or maybe they’ve truly seen a bad RBP experience.
The pundits say:
- “RBP doesn’t work where I’m at.”
- “RBP is too disruptive to members.”
- “Balance bills are too messy.”
You’ll typically notice these voices are selling a niche solution that wouldn’t be needed if RBP was in place. Other times, you’ll notice pundits genuinely don’t think RBP works. I’ll agree with them that RBP is not right for everyone. RBP is not right for highly profitable businesses that can subsidize benefits to the point where they’re affordable for working-class employees. And with each passing year, the number of profitable businesses capable of affording this gets slimmer.
RBP is really hard to get right. It takes a vendor with experience and precision navigating the provider relationships in a way that protects access and the financial incentive of removing the network. Too often, people talk about RBP as if bad execution is the model. It is not. Bad execution is bad execution. A quality RBP program needs proactive communication, provider outreach, member advocacy, balance bill support, legal and compliance discipline, and plan documents that mean something when the pressure hits.
None of that is optional.
Broadly sharing expertise at conferences or on social channels as the truth, when it’s an opinion based on limited information, happens all the time. But what makes these RBP skeptics intolerable is that they oftentimes complain often about horrific network solutions.
Again, I see the grandstanding, and I just want to put them in contact with our clients — who are taking control and winning every day.
Rearranging the Deck Chairs on the Titanic
Progress requires innovation and product launches but, at some point, the advisor must exercise some discernment. Some think if they bolt on point solutions to a network, they can say it’s nontraditional or progressive. We should not confuse managing around the problem with changing the economics of the problem. A better dashboard or a captive strategy doesn’t change the price you pay for healthcare. If the plan is still paying claims based on network discounts, the employer is still tied to the same inflated starting point.
Some think if they bolt on point solutions to a network, they can say it’s nontraditional or progressive. We should not confuse managing around the problem with changing the economics of the problem.
Maybe even more annoying are the voices that say RBP is too disruptive, then support vendor stacks of narrow networks, cash pay, navigation, medical management and restrictive plan designs. I really can’t wrap my head around the lack of critical thinking that goes into those concepts.
The pundits say:
- “In the name of cost containment, we are going to limit provider choice for members, but there is no way we are doing RBP.”
- “In the name of cost containment, we think you should roll out a plan your employees will have no idea how to use.”
Again, we need to connect these strategists with our clients out here executing a straightforward strategy reliant on real human support, auditing claims and multifactor, bottom-up pricing. Our clients are pragmatic operators who deeply understand and have instincts for whether the juice is worth the squeeze.
If we continue to only manage around the problem, it’ll be like what happened with the Titanic: the ship still sank, and it didn’t matter where the chairs were.
Practical Courage > Performative Outrage
If a broker believes the network is a raw deal but keeps walking employers back into the same basic structure every year, that broker is not really challenging the system.
If a pundit wants to hope the BUCAs get broken up, that’s great. If a pundit wants to hope the government does something about chargemasters, that’s great. But in the meantime, that pundit better also have some conviction in strategies that reduce the cost of health insurance for the working class. Not just on the margins, not in theory. I’m talking about a real and sustainable strategy that drives results like RBP.
Being mad at the network is easy. Building a plan that is less dependent on it is harder. Go back to those complaints from “experts” at the start of the article; RBP is the proven answer to all of them.
We don’t need louder outrage. We need these loud voices in the benefits industry to learn from our clients who are running their businesses successfully by taking action and driving change. They didn’t wait and hope for a miracle. Because of employers like them, it’s August, and we’ve already blown past our 2026 sales goal before Jan. 1 renewal numbers have been released. Winners know how to take action.