Employers Managing Multiple Healthcare Shifts Need Brokers Thinking Beyond the Next Renewal

Employers have more healthcare cost data available to them than at any point in history. Updated transparency files from CMS and hospitals now make it possible to look back and see that a $70,000 shoulder surgery could have been done across the road for $20,000. The problem is that most employers still don't know how to use that information on the front end, before the money is spent, and the cost pressure keeps building.

Dylan Melling is Practice Manager at Integrity Benefit Partners, Inc., an Indianapolis-based employee benefits brokerage that advises mid-sized employers on cost containment, plan design, and benefits strategy. Melling works across fully insured, self-funded, and ICHRA models, and sees the market shifting in multiple directions at once.

"We're managing 19 trends at a time right now. Trump Rx, direct primary care, ICHRA, it's all happening at the same time. Employers need a broker who's thinking five to ten years ahead, not just the next renewal," says Melling. That convergence of pressures is pushing employers toward a more hands-on, data-informed approach to benefits, starting with steerage and prescription drug programs as entry points into broader cost containment strategies.

• The PBM gateway: Melling says the easiest conversation for most employers to engage with involves prescription drug costs. "Same drug. If you buy it this way, it costs a thousand dollars. If you buy it this way, it costs $700. Which way do you want to buy it?" That simple comparison, he says, tends to open the door to deeper strategy discussions.

• Steerage that works: The more effective steerage programs involve waiving employee costs entirely when they engage with preferred options. "Employees retain the right to go to the local hospital, pay their deductible, pay their coinsurance. But if you engage with us, we want to waive as much or all of the cost as possible."

• The access crisis ahead: Behind the cost conversation sits a problem Melling says few employers are fully reckoning with: a primary care physician shortage that will reshape how employees evaluate their benefits. "In five years, employees are going to be going to employers not with the question of, is my doctor in network? The question may shift to, do you have a doctor I can go see?" He predicts that the employers who win at benefits over the next decade will be those who can guarantee timely direct primary care access during the hiring process.

That access problem also undermines traditional network-based plans. Melling says the reliance on large carrier logos is weakening as members discover that 20 in-network cardiologists listed means nothing if none have openings. "If your benefits plan is built on a restrictive network, that's going to become worse and worse for people over the next five to ten years." For employers considering ICHRA as an alternative, Melling offers a measured view. His agency has written ICHRAs for five years and sees both the appeal and the limits.

• The spreadsheet trap: He cautions against brokers who make ICHRAs look like guaranteed savings on a spreadsheet. "You can make the numbers show a savings, but that's a false trap. Are you benchmarking against bronze plans, silver plans, gold plans? In reality, a lot of employer-based plans would be rated as gold on the marketplace, but the marketplace gold plan doesn't have the same bells and whistles."

• Building blocks matter: Where Melling sees ICHRAs work best is when they are paired with additional programs rather than deployed alone. "We've had clients pairing ICHRAs with direct primary care access, drug programs where generics ship at no cost. Now the employee walks away saying, I've got a free doctor in my pocket and my prescriptions covered. That's when employees feel like they're actually benefiting."

• Marketplace erosion: His bigger concern is what happens to the model over time. "We've been writing ICHRAs for five years. The available choices on the marketplace every year just look a little bit worse. The gold plan today feels more like the original bronze plan from five years ago." The question he poses is whether personalization is useful when employees are choosing from a set of options that are all deteriorating.

Melling is clear that no single solution fixes American healthcare. But he sees a path forward in giving consumers more ability to shop for care across settings, paired with plans that allow credit for out-of-network savings rather than penalizing it. "Does ICHRA by itself solve healthcare costs spiraling out of control? Absolutely not. But allowing people to shop more for their services and their drugs will only benefit us all in the long term," he concludes. "The more of those conversations we can build into the marketplace, the easier this is all going to be."