Instead, Contorno's firm focuses on a different question: How can we change the cost and quality of the medical care that everyone is going to consume, no matter how healthy their habits? “In no way am I suggesting that we sacrifice quality for cost,” Contorno says. “But we still need to educate and incentivize consumers to be better consumers of health care. When quality doesn't matter, go to the lowest-price place. You get the same MRI wherever you go.”

There are lots of possible tools to help accomplish that, Contorno says, with the choice largely dependent on how much engagement leadership is willing to offer. “We can arrange a high-quality telemedicine service,” he says. “Many of the things we visit the doctor for can be handled via telemedicine. Is the CEO willing to be the first person to use this?”

His firm also helps employees understand that what the company health care plan pays out this year affects costs next year, and the company provides workers with an app that automatically price checks prescriptions to see if a better deal is available nearby. The same app offers users telemedicine when they are in the emergency room, to potentially save the hassle and cost of hospital services.

Employers can ratchet up employees' incentive to use lower-cost care with reference-based pricing, Contorno says. “You can make people pay the difference between a reasonable cost for a medical procedure and a higher price, if they choose the more expensive service,” he says. “Most employers are looking at what Medicare would pay and pay a multiple of that: perhaps 140 to 150 percent of that number.”

Medibid, a service that searches for and compiles metrics on medical costs, including how often a given provider performs a particular procedure, information from the Center for Medicaid Studies or its own internal data on outcomes, can help define what's reasonable. “On average, this service saves 40 percent to 60 percent, though it may involve travel across the country,” Contorno says. “If employees choose to travel, the employer typically pays for their travel expenses and either reduces or eliminates their share of the out-of-pocket costs. We can include overseas providers as well, though many employers are uncomfortable with that.”

Managing costs with voluntary and supplemental insurance

Of course, keeping a lid on health care costs isn't the only way to add value to a client relationship. Eric Silverman, principal and owner of Silverman Benefits Group in Bel Air, Maryland, runs a boutique agency focused on voluntary insurance. “The brokers I work with are focusing on value-adds more than ever,” he says. “Many of the carriers are starting to offer a lot of the value-adds that I used to have to pay for or search out.” Those include enrollment implementation solutions, administrative support (internal and carrier specific), communication and marketing, and wellness initiatives.

Supplemental insurance is another way to help clients manage bigger benefits. “All businesses struggle with the rising cost of health care and providing the best benefit package. Supplemental is an opportunity to educate business owners on how they can better manage their benefits package for recruiting and retention,” says John F. Means, president of Grahan Suddoth LLC in Baltimore, Maryland.

With both health care policy deductibles and medical costs rising, fewer and fewer employees can afford a surprise bill of $1,000 in the case of a serious medical situation, Means says. “A supplemental policy can help pick up a deductible, and it can help a lot in a catastrophic situation—accidents, bad illnesses,” he says. In five to 10 years, Means believes a lot of companies will both offer and pay for supplemental coverage, instead of asking employees to pay for it if they want it. “That lets employers save money overall by having higher health coverage deductibles and a way of helping employees pay them.”

It's also sometimes possible to improve absenteeism and worker's compensation rates by adding supplemental coverage, Means says. “A cash infusion can be helpful during catastrophic situations in lieu of disability. We're seeing interest in coverage from both employees and their families.”

Strategic advisor and a one-stop shop

That's a lot of needs for one client to manage—and most clients don't want to be the ones to manage those needs, says Mark Gaunya, co-owner and chief innovation officer at Borislow Insurance in Methuen, Massachusetts. Nor do they want to coordinate nine or 10 vendors. “They want one vendor to manage all those needs,” Gaunya says. “It's not just about carrying insurance products anymore; it's about being a strategic advisor to the CEO, CFO, and human resources people.”

Gaunya says he works to educate clients, particularly CFOs, about their benefit plans, how those plans are performing, and how multiple benefits can link together.

Compliance details are often a point of confusion, so Gaunya helps clients stay in compliance with state, local and federal law. “PPACA focused on insurance reform, not health care reform, and it includes a lot of rules and regulations based on employer size, with fines that are business-crippling and potentially business-ending if you're out of compliance. I tell them the rules of the road. I can't drive for them, but I teach them how to drive.”

Along the way, Gaunya also handles underwriting, health and well-being, communication and education, benefits for companies with an international presence, Medicare benefits for retirees, human resource consultation, insurance and investments practice—including group insurance voluntary and supplemental insurance, optional individual life insurance, long-term care coverage, disability insurance, and retirement planning for individuals—and employee benefit consulting.

“The key now is the ability to manage all these parts and pieces and put together one or more to create a unique solution for an individual client,” he says.