“We have some different approaches. We’ve pushed people to these higher out-of-pocket costs plans, and we called it ‘consumerisum’ and have worked for years now, but the out-of-pocket costs are continuing to grow there, too. Members need tools to help them be better consumers,” he says.

Keep in mind this tirade came by way of asking what, specifically, he does at Benefit Brainstorm, a company he started just three years ago, on the eve of the Patient Protection and Affordable Care Act’s passage into law – kind of like picking up some Facebook stock at the opening bell.

At its simplest, Rasmussen’s firm design and packages ancillary benefit plans – working with both carriers and brokers to offer clients the most comprehensive – and affordable – benefits plans. (And, no, we didn’t just rip this off the company’s website.)

But I’ll let him finish the story.

“Most agents have done a poor job of actually finding some of those tools,” he continues. “There are companies out there doing a good job in this space, but the practical issue is they cost so little that a lot of agents don’t go and do their research to go find three (or four, five or six) of these different consumerism tools to implement because they make so little money off of them. And it’s not an insult.

“What we did at Benefit Brainstorm was we saw there were some good ideas out there. They [were] marketed by people focused on just one little portion of the puzzle and didn’t have an insurance background so they couldn’t message it properly for an agent. So we’re a single-source solution for non-insurance benefits with the goal of working with these various vendors who have these other tools.”Now that we’ve gotten that out of the way, how’s business been?

“It’s good. [I’ve learned] you need a different message whether you’re talking to small group, large group or an individual. And so a lot of what we’ve learned in the first few years is how to finesse that differently for the large group vs. small and individual sales. We’ve found a lot of the innovative brokers who are more strategic in their approach and in their sales. We’ve worked with a few carriers to build programs with them.

“Regardless of what happens, our business is gonna continue. But reform is pushing innovative ideas to the forefront, so we’re winning more because of reform and because it’s pushing brokers to find some of those unique solutions.”

Benefits Selling: I’ve found brokers won’t really look for that sort of thing unless they’re forced to…

RR: I’d agree with that. You know you take something like telehealth. It’s been around for a decade. It’s been available at the small broker level for a little while. It’s a new idea, it’s different and in the past the broker would look at it and say, “Well, I don’t make that much money with it.” Whereas now they’re so much more open to say, “I have to find different ways to serve my clients.”

Their clients have been pushed to the wall as far as costs go and they’re being pushed to find new ideas. You know none of us change if things are working well, and we’re making a ton of money.

BS: So where do you see yourself going forward. What does the next year or two look like for you?

RR: Nothing but growth. We’re seeing tremendous interest from brokers. A lot from those who work on large [cases] because those larger groups … are looking for everything they can do – beyond just wellness programs – to cut down their loss ratio and so our services more than pay for itself. A company loses money every month they don’t have our programs in place.

Carriers are starting to wake up again to some new ideas. They’ve been so busy with health care reform for so much of the last two years that many of them couldn’t think about a different idea even if it made complete sense to their bottom line. So we’re getting some carriers who’re looking for how they can expand beyond just medical. And more and more brokers we see are looking for new ways to help clients and make money. In all those categories we’re seeing growth, so that’s our biggest issue: figuring out we’ve got to focus our energies on those really producing the biggest bang for the buck. A lot of the next year is going to be staying focused on those who are very strategic and ready to move. And brokers who are just kicking the tires. We aren’t gonna spend as much time with them as we have in the past.

BS: You’re in a unique position to weigh in on the relationship between brokers and carriers. How are things?

RR: I worked for both carriers and general agencies over the years. Now I’m an independent. I think brokers are all looking at the carrier relationship as a love-hate relationship. Maybe that’s not the phrase. I don’t know that I’d say it that way but here’s what I would say: I don’t think the commission cuts are done.

Last year around the country we saw a lot of carriers cut about 10 percent on the standard commissions. I think there’s probably another 10 percent deduction that will probably find it’s way into the market over the next two years. And there aren’t many people actually saying that. I think the – I think there will be some efficiencies that come out reform that will make business a little bit easier to process. Some of the forms, some of the processes for submitting business will be more consistent across carriers. So maybe it will be OK the prices come down a bit.

BS: How do you see brokers responding?

RR: My guess is that a third of today’s brokers will be out of the business in a few years. Our average age is, what, 57? I speak to groups of brokers around the country and it just looks to me that a lot of them aren’t gonna relearn the whole industry all over again.

I think the other brokers who are there, those who change and are much more strategic and are willing to change the way that work will pick up new business. They’ll learn how to serve the clients in more ways than they ever did before. I think clients or brokers will bill for certain services whether its HR consulting or government reporting consulting, there will be areas where they’re billing for services they wouldn’t have thought they would be. So I think brokers will do fine. I think people want advice. They want an advisor, but the brokers who stick around are gonna be those who ‘do business differently in the future than you do now.’ And I think those brokers who do will do very well.

BS: Do you also see voluntary products playing more of a role?

RR: A lot of the brokers have never really learned how to sell differently into the voluntary space, as you know. And a lot of agents might have dabbled in it. I won’t say I’m an expert in voluntary, but I think an agent is blind if they’re not trying to figure out how to work in that space.

BS: What about the potential death of the employer-paid benefits model? What does that mean for brokers? Or do you even buy into that at all?

RR: I think employers are still gonna be involved in benefits. I’m from Canada originally. And in Canada a lot of employers are still the channel to provide benefits to employees. And this is 45 years after it was implemented as a much more nationalized program than we’re gonna have here. So you know it works there and it continues to be sold that way. So I think some employers will get out of it; yeah I do. And I think that dynamic of why an employer provides benefits will change. Instead of it just being “I have to do this” they’re gonna very consciously understand why they’re providing benefits to their people and why they want to. So I think some brokers will remain in the employer market and will get better at articulating why an employer would want to provide benefits to their people, and they’ll talk about the social aspects within their group and they’ll talk about the financial and they’ll talk about the issues more than we have sold that in the past decade, right? I think there will be tens of millions of Americans who used to get benefits through their employers who will be out on the open market. I think it will be a huge market for people who can talk to a consumer about their benefits.

BS: In that regard you can almost argue there’s this huge opportunity that’s coming as much as a you would argue it’s a disaster?

RR: I completely agree. Like I said, it will be different: It will be those brokers who are strategic and willing to change the way they do business, not do it the same old way. The entire industry needs to learn to be able to talk to the consumer better than they ever have. They’re horrible at it. And in that sense people who have the voluntary experience will smoke the brokers who don’t understand voluntary sales.

BS: So on the consumer side, do you see further growth there, too.

RR: Completely.

BS: Do you see the consumers getting it more than they used to? Or are they just being forced to?

RR: Honestly, not really. I see a certain population of the country care about their health and fitness. And I see a whole bunch of others who know they should eat less and they should move more and just don’t. And they don’t want to be told what to do and I think wellness programs within companies are good. But honestly it’s not like we didn’t know we should be healthier. It’s not an information issue; it’s a motivation issue.

But do I think consumers understand their health care more? I think there’s appetite for them to understand it more. I think they’re completely frustrated with the system we’ve created. One of the services I mentioned we implement are advocacy services and basically it’s like having a friend who’s an industry insider in the insurance business. People love the idea of having somebody who can help them navigate the system. They want to able to navigate it more and they want to be able to navigate it better, but they really don’t understand anything we’re throwing their way. Explanations of benefits are explaining anything, and it’s no benefit to anybody. It’s a waste of paper, and people need somebody to explain it to them and so that’s why we have these services. I think we’re gonna see great opportunity with things like outsourcing those services. People need help. And they do – to answer your question which you started with is “are people getting it more?” I don’t think they are but I think they’d like to.

BS: So are we seeing the death of the small group?

RR: I think there will be a tremendous fluctuation in the small group market in the next couple years. I think what will potentially happen is agents will lose the small book group of business right now, we’ll be going through the exchange because the members will get subsidized if they go through the exchange

Why? Because 53 percent of the population will get a subsidy if they go through the exchange. I think we’re gonna see half the population go through the exchange for their medical. And so that’s a huge incentive for employers and small groups to shift where they get their medical and I think we’re gonna see it happen. I think brokers are gonna see a tremendous amount of their book gone. They’ll scramble to figure out how they can sell anything else to those people, keep them as clients. And that’s where I’m very positive about our business and where some of our growth opportunity is: cross-selling to small groups because brokers are frantic to serve those people other products.

BS: So do you see us headed down that path?

RR: America’s social structure is different than every other country in the world that has nationalized health care. And as such I don’t think it will play out the same way here that it has in other countries. But every time I talk to the people, they’re upset by their insurance. It’s confusing and they feel as out of control with it as they think it would be if they go to the government. So it’s kind of how we’ve gotten here. I really wished we hadn’t and I think the freedom-thinking American isn’t going to play well with a nationalized health care program like Canada’s. But I’m concerned how much the government is getting involved in the health care system. I don’t think it’s gonna bring efficiency. I don’t think it’s gonna bring lower costs. I think it’s gonna bring a lot of burden of bureaucracies and I don’t think that will play well in America.

BS: So are we responsible for where we are?

RR: I wish five years ago we, as an industry, had embraced transparency and consumerism. We spoke about it, a few things got implemented but we didn’t pursue it like our livelihoods and the freedom of choice in the American health care system depended upon it. We might have missed the window. I won’t blame the carrier. It’s one-sixth of the American economy. We’re all responsible. And the public is responsible for not rioting when the bill got signed by a minority two years ago. I won’t blame carriers, I won’t blame agents. But we’re here now.