Online Benefits Technology

2006 was the year I got my start in health insurance. The prior year I had run the cafe at my school, an experience that turned me on to the idea of being an entrepreneur. Still a student with one year left in my program, my health law classes had me pretty stirred up about all of the misaligned incentives in healthcare. Health Savings Accounts (HSAs) were relatively new at the time, and a concept that I thought was the first step to realigning those incentives. My first idea as to start a bank that focused on Health Savings Accounts. A price comparison tool for healthcare was another idea. A Nashville-based venture capitalist asked me what kind of business I would start around HSAs if I wasn’t going to raise any money at all — that question spurred me to decide to get my health insurance license and be a broker. As a broker, I’d be on the front lines and would figure out why employers were not adopting HSAs as quickly as many policy analysts had expected. I’d explain to them what it meant for the healthcare system. I’d help spur the change so many believe needs to happen to make our healthcare system more effective. And so with those inspirational thoughts in mind, I got my insurance license, put together my presentation on the history of healthcare and how HSAs were the key to making things better, and started calling employers to spread the word and become their broker. Boy, was I naive. I started to sense I my own naivety when I wasn’t getting any clients. The employers I met with were all respectful. They listened to my “pitch” and would even share their own healthcare frustrations with me. But they didn’t hire me. Until Becky Sharpe. The visionary owner of Scholarship Program Administrators, which has since changed its name to International Scholarship and Tuition Services, hired me on the spot. She had read about HSAs herself and recently had tried to implement them. Only two out of her fourteen employees took the HSA option and her broker had told her that any money not spent from the HSA would automatically go into employees’ 401(k). Remember, this was 2006 when HSAs were still new for everyone. In order for HSAs to really work for Becky’s company, I recommended that she change to a different insurance company that offered more favorable HSA-based plan designs. She agreed. The amount of paperwork that ensued was amazing. What was more amazing to me was that all parties — Becky, her office manager, the insurance company — seemed to be on the same page that the paperwork was my responsibility. Remember, I had become a broker for the noble pursuit of improving the U.S. healthcare system, not to process paperwork. But given this was my first client, I was all over it. I checked to make sure every “i” was dotted and “t” crossed — and still missed things. Eventually, though, the paperwork got squared away, the rates finalized, and I got the opportunity to present the new, HSA-based plan to Becky’s employees. Almost to a person, they loved it. Becky was saving so much in premiums that she was able to help fund the employees’ HSAs so that everyone could win. They all agreed that I explained it much better than the prior broker. It felt good. A few days later, Becky’s office manager called me. She was frustrated. Employees had made their elections, but she wasn’t sure when to start making the deductions from their paychecks. And how was the employer’s HSA contribution supposed to be reflected in their payroll system? And could employees just change their HSA deduction whenever they wanted? Why was her payroll company telling her she needed more than one payroll deduction code to accommodate HSAs? Also, how were the contributions supposed to be made to the bank? Finally, the accountant wanted records for where all of this money was going — how were these reports supposed to be made efficiently? As I was listening to her, I remember wondering why these questions were being directed to me. Wasn’t I supposed to be the healthcare advisor? What did that have to do with payroll deduction codes? But I drove out to meet with the office manager, and help her through all of these questions. At the time I figured it was just one needy client, and the time spent well worth it as I was trying to get my business going. But then it was the same thing with my second client. And my third. And fourth. Every client had these issues, and they all expected me to resolve them. I eventually began to appreciate that the small employers I was calling on did not see it as their responsibility to fix the U.S. healthcare system. They had their own problems to deal with. I wanted to be their trusted healthcare advisor, but if I didn’t meet them where they were, they were not going to let me have that role. Furthermore, because so many of a small employer’s most acute, day-to-day healthcare headaches are transactional in nature, meeting my prospects where they were meant addressing transactional problems. That insight is what eventually caused my company to embark on building BerniePortal, the web-based HR and Benefits platform built in harmony for brokers, employers, and employees. As someone who has thought about and worked on this problem for the last ten years, in the rest of this book I’m going to share: Part 1: The decision you face Part 2: What to look for in a system Part 3: How to implement your system I’ll also share some anecdotes along the way — both from my time working as a broker and from my experience as part of the team building BerniePortal.