Latest / Becker’s Payer Issues Podcast / The Rise of ICHRA: Flexibility, Choice and the Future of Health Benefits with Hunter Foster

Transcript

The Rise of ICHRA: Flexibility, Choice and the Future of Health Benefits with Hunter Foster · Becker’s Payer Issues Podcast

• 0:00
  - Hello, everyone. Welcome to Becker's Healthcare podcast. I'm
• 0:02
  - Scott King. Thrilled today to be joined by
• 0:04
  - a very special guest, Hunter Foster, vice president
• 0:07
  - of agency operations and strategy over at Benefit
• 0:09
  - Bay. Hunter, how are you doing today? Thanks
• 0:11
  - so much for joining us. Yeah. I'm doing
• 0:12
  - great. Thanks for having me. Of course. You
• 0:15
  - know, we have a lot of of big
• 0:16
  - kind of topics and trends
• 0:18
  - in health care and with health plans. I
• 0:19
  - I definitely wanna get your opinion and expertise
• 0:21
  - on, Hunter. But before we do that, I
• 0:23
  - was wondering if you could please just share
• 0:25
  - a little bit about your career journey.
• 0:27
  - Yeah. Absolutely.
• 0:28
  - Long time listener, first time caller here, so
• 0:31
  - happy to to join in. So I would
• 0:34
  - say my career path is a bit unique.
• 0:37
  - I actually started
• 0:38
  - as a bedside nurse.
• 0:41
  - So spent seven years in the hospital,
• 0:43
  - ranging from bedside nursing all the way up
• 0:45
  - to hospital management.
• 0:48
  - That started in 2016,
• 0:50
  - and I worked all the way through
• 0:52
  - COVID, which was a a challenging time to
• 0:54
  - be a nurse.
• 0:56
  - It was also a time where I got
• 0:58
  - to experience
• 0:59
  - probably the most growth in my career,
• 1:02
  - and it it really
• 1:03
  - accelerated,
• 1:04
  - my ability to, you know, my confidence to
• 1:07
  - pivot into
• 1:08
  - other fields in health care adjacent
• 1:11
  - companies.
• 1:12
  - So following the second wave, I moved to
• 1:15
  - a,
• 1:16
  - I would say,
• 1:18
  - health care adjacent
• 1:19
  - start up,
• 1:20
  - and spent about two years over there in
• 1:23
  - the managed care side.
• 1:25
  - After those two years, I I landed on
• 1:27
  - the opportunity with Benefit Bay. I'm from Kansas
• 1:30
  - City, which is where we're headquartered.
• 1:32
  - And so with a little bit of luck,
• 1:34
  - I landed here and started as a contractor,
• 1:37
  - came on in 2024
• 1:39
  - as a director standing up our agency, and
• 1:42
  - been here ever since.
• 1:44
  - Appreciate you sharing that background info. You know,
• 1:46
  - you you've certainly
• 1:48
  - worn a a lot of different hats in
• 1:50
  - in health care and certainly in the thick
• 1:52
  - of things during COVID as a nurse.
• 1:54
  - Thanks so much for sharing.
• 1:56
  - And, you know, I I know Benefit Bay
• 1:58
  - operates as a private health insurance marketplace for
• 2:01
  - individual coverage,
• 2:03
  - but what gap in the traditional group health
• 2:06
  - plan model made you confident
• 2:08
  - that that approach could work at scale?
• 2:11
  - Yeah. Absolutely. And
• 2:13
  - I I bet you're expecting me to say
• 2:15
  - price control here, so I won't bore everyone
• 2:17
  - and I'll I'll change it up a bit.
• 2:19
  - Okay. I will say failure to innovate.
• 2:22
  - And so
• 2:23
  - just like any industry,
• 2:26
  - we see incumbent companies
• 2:28
  - passed or replaced by new entrants because they
• 2:31
  - they struggle
• 2:32
  - to part with legacy ways of thinking
• 2:35
  - and adapt to new processes and needs of
• 2:38
  - the consumers.
• 2:40
  - So
• 2:41
  - I I think those legacy ways of thinking
• 2:43
  - have have held back the the traditional
• 2:46
  - status quos while ICRA is emerging as a
• 2:49
  - a viable option,
• 2:51
  - that solves not all employers' needs, but at
• 2:54
  - least
• 2:55
  - a a number of them. It's just another
• 2:57
  - tool in the tool belt.
• 2:59
  - So when I joined Benefit Bay to start
• 3:01
  - our agency from scratch, there was a
• 3:04
  - lot of nerves there, but the passion of
• 3:07
  - the team, I would say,
• 3:09
  - and the freedom of not having to work
• 3:12
  - from an antiquated playbook, that gave me the
• 3:14
  - confidence to build both efficiently and intuitively
• 3:19
  - and answer the problems that were, occurring back
• 3:22
  - in the I would call that early days
• 3:24
  - of it. Correct?
• 3:25
  - You sit at the intersection
• 3:27
  - of running agency operations and shaping strategy.
• 3:31
  - How do those two roles inform each other
• 3:33
  - day to day?
• 3:35
  - Yeah. And this is actually my my favorite
• 3:37
  - part about my role. It's a, you know,
• 3:39
  - broad set of responsibilities.
• 3:41
  - You don't often see that combination,
• 3:44
  - but it allows me a lot of insights
• 3:46
  - into the needs of the company. And, you
• 3:48
  - know, as much as I enjoy shooting from
• 3:50
  - the hip from time to time, I think
• 3:52
  - it makes a lot more sense to guide
• 3:53
  - the direction of our company based on what
• 3:56
  - we're seeing on the front lines.
• 3:59
  - You know, it sounds cool to pivot the
• 4:00
  - company to maybe
• 4:02
  - NFT
• 4:03
  - day trading platform or something, but it probably
• 4:06
  - makes more sense for me to speak with
• 4:07
  - our enrollment team and hear the problems that
• 4:10
  - the the members we're serving are experiencing
• 4:13
  - and then
• 4:14
  - make changes based on those.
• 4:17
  - Employers are increasingly exploring ICHRA
• 4:20
  - and and defined contribution models
• 4:23
  - as alternatives to traditional group plans. What's driving
• 4:26
  - that shift, and is it accelerating or plateauing
• 4:29
  - right now, you think?
• 4:31
  - Yeah. Yeah. Absolutely
• 4:32
  - accelerating, and I I think that's for a
• 4:34
  - number of reasons.
• 4:36
  - To list a few, I would say, pricing,
• 4:39
  - predictability,
• 4:41
  - flexibility,
• 4:42
  - and
• 4:43
  - even autonomy
• 4:44
  - of the employees to to choose a plan
• 4:47
  - that makes the most sense for them.
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  - The thing I feel best about here is
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  - that pressure and the acceleration is is coming
• 4:55
  - from all stakeholders. So it's not just the
• 4:58
  - employers,
• 4:59
  - or the brokers.
• 5:01
  - We actually had a a group last year
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  - that the employer had made the decision to
• 5:07
  - go back to group. That was around October.
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  - And so
• 5:11
  - they made the switch.
• 5:14
  - They had started their open enrollment for their
• 5:17
  - group plan, and the employees
• 5:19
  - essentially revolted.
• 5:20
  - And
• 5:22
  - they didn't wanna give up that flexibility in
• 5:24
  - the the
• 5:26
  - opportunity
• 5:27
  - to choose their own plan. And so, ultimately,
• 5:29
  - they end up coming back, and we made
• 5:31
  - it work on a tight turnaround.
• 5:33
  - But that was a a really, really cool
• 5:36
  - example of,
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  - you know,
• 5:39
  - everyone
• 5:41
  - that experiences ICRA wants it to be sticky.
• 5:44
  - Appreciate you sharing that example.
• 5:46
  - I also wanna ask you, what's the biggest
• 5:49
  - misconception employers have about moving
• 5:52
  - employees to an individual marketplace model?
• 5:55
  - Yeah. I mean, this one is a an
• 5:58
  - easy one. And I would say,
• 6:00
  - it's that their employees
• 6:03
  - are not
• 6:04
  - equipped to make these decisions and choose their
• 6:07
  - own plans.
• 6:09
  - And I think, you know,
• 6:10
  - for example here, I'm not an electrician, but
• 6:14
  - with thirty minutes and some YouTube, I was
• 6:16
  - able to replace my light switch in my
• 6:18
  - house.
• 6:19
  - And, you know,
• 6:21
  - it's actually probably a bad example because that
• 6:24
  - light still flickers.
• 6:25
  - But
• 6:26
  - the point is
• 6:29
  - if you partner with the right admin
• 6:32
  - and equip your employees with resources and enrollment
• 6:35
  - support,
• 6:37
  - they can make this decision. And after a
• 6:39
  - while, you know, they get one open enrollment
• 6:42
  - under their belt.
• 6:43
  - They feel completely empowered.
• 6:46
  - How do you help brokers
• 6:48
  - and agents get comfortable
• 6:50
  - recommending a model that's fundamentally different
• 6:52
  - from what they've sold their entire careers?
• 6:55
  - Sure. Yeah. It
• 6:57
  - it is different, and it's uncomfortable at first.
• 7:01
  - Especially, you know, brokers are used to being
• 7:03
  - the expert at the table, and so we
• 7:06
  - just have to support them until they
• 7:09
  - gain that comfort level with ICRA.
• 7:12
  - When, you know, I was learning to ride
• 7:15
  - a bike,
• 7:16
  - my my dad started with teaching me and
• 7:18
  - slapped a helmet on and pushed me down
• 7:20
  - a hill.
• 7:21
  - That didn't go well. And so my mom
• 7:23
  - took over, and she would put me on
• 7:25
  - the bike and run alongside me until I
• 7:27
  - I could pedal. And so that's kind of
• 7:29
  - the approach we have to take. You know?
• 7:31
  - You have to be there to support them
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  - every step of the way
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  - and make them feel comfortable with what they're
• 7:37
  - presenting to their clients.
• 7:39
  - So a great a great, example I can
• 7:41
  - relate to as we're we're teaching my credit
• 7:43
  - now in my family. So, best to let
• 7:46
  - mom take care of it.
• 7:48
  - What does what does a successful
• 7:50
  - ICHRA
• 7:51
  - implementation actually look like
• 7:53
  - operationally, and where do most employers underestimate the
• 7:56
  - complexity of it?
• 7:58
  - Yeah. I, you know, I I think something
• 8:00
  - that's missed a lot of the time is
• 8:03
  - the
• 8:05
  - change management,
• 8:06
  - the rollout, and the education
• 8:09
  - before you even get to that enrollment period.
• 8:12
  - That's what makes or breaks an implementation.
• 8:15
  - So, you know, the webinars and the resources
• 8:18
  - that you're able to provide to employees,
• 8:21
  - getting them used to the concept before they're
• 8:23
  - asked to log in to a platform and
• 8:26
  - select a plan from a list of 40
• 8:28
  - options,
• 8:30
  - that goes a long way in in a
• 8:32
  - smooth transition.
• 8:34
  - How are you speaking about the role of
• 8:36
  - AI or or just emerging tech
• 8:39
  - in general in simplifying the individual
• 8:42
  - marketplace shopping experience for employees who aren't, you
• 8:45
  - know, insurance savvy?
• 8:47
  - Yeah. I mean,
• 8:49
  - when I'm not thinking about it, I'm I'm
• 8:50
  - hearing about it. So I I try to
• 8:53
  - maintain
• 8:54
  - a a cautious optimism.
• 8:57
  - I I see the opportunity there and absolutely
• 9:00
  - can
• 9:01
  - completely evolve how we think about decision making
• 9:04
  - and some of the other products that we're
• 9:06
  - able to wrap in with it for Even
• 9:08
  - just looking at, you know, HSA dollars and,
• 9:11
  - formulary cost for specific plans,
• 9:14
  - we're going to get there, but
• 9:17
  - the worst thing we can do is roll
• 9:18
  - that out before it's ready. So I'd I'd
• 9:21
  - rather pay a team of 500 enrollers before
• 9:24
  - I put
• 9:25
  - a AI solution that is going to misrepresent
• 9:29
  - a plan or lead a individual to a
• 9:31
  - bad outcome. So
• 9:33
  - I'm not to a point where I'm completely
• 9:36
  - comfortable, but we are
• 9:37
  - rolling out some basic tools that just put,
• 9:41
  - you know,
• 9:42
  - tool tips essentially in front of of individuals,
• 9:45
  - and I I think that will continue to
• 9:47
  - evolve over time.
• 9:49
  - And the last question I have for you,
• 9:51
  - Hunter,
• 9:51
  - from an agency operations perspective, what's changed most
• 9:55
  - about how brokers need to operate to succeed
• 9:57
  - in this space,
• 9:59
  - over the next five years?
• 10:01
  - Yeah. So
• 10:02
  - as you know, this this space is
• 10:05
  - is rapidly moving. And I I think the
• 10:08
  - the big change that we've seen
• 10:10
  - recently is
• 10:12
  - there were brokers who were were selling ICRA
• 10:15
  - and then,
• 10:16
  - you know, some were still on the fence.
• 10:18
  - And we saw
• 10:20
  - brokers actually
• 10:22
  - using that as a a lever to to
• 10:24
  - gain clients. So they were putting ICRA proposals
• 10:27
  - in front of other groups as a a
• 10:29
  - way to win them over. And I think
• 10:33
  - that has helped with buy in.
• 10:35
  - I think over the the next five years,
• 10:37
  - the the biggest shift that we'll continue to
• 10:40
  - see and it's really this year picked up
• 10:42
  - is
• 10:44
  - the buy in from carriers and
• 10:46
  - them wanting to participate
• 10:48
  - more actively.
• 10:49
  - So
• 10:50
  - wanting to
• 10:51
  - introduce Acura specific products into their
• 10:54
  - brochures and
• 10:56
  - leaning on the admins for the data
• 10:59
  - they need in order to design those products.
• 11:02
  - Hunter, thanks so much for joining us on
• 11:04
  - the podcast. It it was a great conversation.
• 11:06
  - I look forward to working with you again
• 11:07
  - soon. Yeah. Absolutely. I'll I'll see you in
• 11:10
  - Chicago in not too long.