Moreover, a lot of plans now have smaller networks of doctors, particularly in certain states, he says. On top of that, there is a growing doctor shortage. According to a survey by the Association of American Medical Colleges, within 10 years, there will be roughly 46,000 too few doctors in the country, leaving many people without a family doctor.

Turning the tide

“So how do we as an industry deal with these issues?” Rasmussen asks. “As more people migrate to consumerism plans with higher out-of-pocket costs, they have more skin in the game and more reason to research the best quality care and the best-priced care. As HR professionals have less time today to coach employees on how to research cost and quality, there are non-insurance tools brokers can suggest that can help out.”

One popular example of such a tool is telehealth, he says, which gives participants the ability to have a primary care physician visit over the phone or video, and even receive a prescription, if appropriate. There are many vendors in this space and tens of millions of Americans now have access to these kinds of services.

According to the Towers Watson 2015 Emerging Trends in Health Care Survey, about 38 percent of large employers have some kind of telehealth service, and within two years, that number will have doubled. A lot of brokers who work with smaller employers are also now educating them about these services.

The next level of telehealth is an online doctor service with specialist consults via email, Rasmussen says.

“This helps round out the issue of smaller networks and higher out-of-pocket costs, by handling some of the simpler specialist visits,” he says. “For example, someone getting treatment for white blood cell counts and getting conflicting advice from several doctors, might want to email a specialist. They can send over their white blood count tests and tell the specialist what they've been hearing from the doctors, to get the specialist's second opinion. The specialist might also suggest questions they should ask their doctor.”

Expanding solutions

Another service is advocacy, for example, learning about the best quality place to get knee surgery within one's network. “These services can also help people get appointments with tough-to-find physicians or help with bill negotiations,” Rasmussen says. “Advocacy is vital as people push back against price more and more due to rising out-of-pocket costs.”

Ancillary discount networks are available for all types of health care services, including pharmacy, dental, vision and more, he says. A savings network doesn't cover the cost of the service, but it provides a significant savings. Many employers no longer provide dental or vision insurance for employees, so this is a sensible transition product to at least provide employees with some savings.

Moreover, there all kinds of vendors and non-insurance products available, offering everything from identity theft and legal services, to chiropractor networks, pet care savings, retail savings and other lifestyle programs.

“In the past, a broker only provided insurance solutions,” Rasmussen says. “Today, if your goal is to be a benefits consultant, then the key approach is to look at your clients' problems and find services to solve those problems; whether insurance or non-insurance. This approach definitely involves changing how brokers define themselves.”

Real value

Don Hansen, co-owner of Concierge Benefits Services in Omaha, says concierge benefits are growing in popularity because they are “the shiny object right now, and brokers tend to gravitate to the shiny object being marketed to them.”

But there is a reason they are the newest, hottest offerings, Hansen says. Many of these concierge benefits bring real value to the consumer and, if implemented properly, can dramatically save time and money.

“With the right approach, concierge benefits provide low-cost, high-impact solutions to health care issues plaguing employers, employees, families and the health care system as a whole,” Hansen says. “The ability to implement different types of concierge benefits that drive utilization away from the underlying health care plan can have a direct impact on lowering premiums, decreasing rate increases and more importantly, provide access to more effective and efficient health care.”

Hansen agrees with Rasmussen that telemedicine can have a powerful impact on medical care for the consumer. “It doesn't matter who you are, we're all feeling the pain of the current health care system. Consumers want and need a better solution. Telemedicine provides a better way to access health care and reduce health care costs.”

People using telemedicine get 24/7/365 access to U.S.-based, properly licensed physicians who provide acute care via email, phone or virtual chat and, when appropriate, can prescribe certain medications without having to see the client in person. Beyond the similarities between different telemedicine vendors, there are two models of delivery—a fee per use model and a monthly subscription model.

Another example of a concierge benefit is medical bill negotiation services, which can save consumers money above and beyond the network discounts promoted by the health insurance companies, Hansen says.

Most negotiation services charge a percentage saved at the backend, ranging from 25 percent to 40 percent of the amount saved.

He is also seeing a rise in the popularity of medical tourism, which creates a true free market approach to health care by getting doctors to bid on the cost of a client's medical care. The practice empowers consumers by creating competition for their medical care, transparency in the medical costs and encouraging them to know everything about doctors, including their malpractice history.

Another example of “cutting-edge” concierge benefits are the DNA tests available to consumers, he says. The tests are created by laboratories across the globe for issues ranging from allergy testing, to how a person's body metabolizes fats, carbs and proteins and responds to different types of workouts. There are also DNA tests for cancer patients to determine which medications and treatments would work best for them.

What's next?

“These services are right at the very beginning of exploding in popularity,” Hansen says.

Erin Krehbiel, president of ACI Specialty Benefits in San Diego, says her 30-year-old firm has been a “trailblazer in contemporary EAP” in an “often commoditized sector.”

“We work with clients to make the EAP have greater impact, including proactive promotion and marketing,” Krehbiel says. “We promote available services in a positive manner, showcasing how the programs can meet workers' mental health needs, lessening the old-fashioned stigma of utilizing an EAP.”

While she says other programs still use flyers with “antiquated” images and words, her company uses “more uplifting pieces” about how its EAP programs can help workers with balancing their life. They emphasize services for coaching, positive development, or handling life issues such as legal, financial, child care, elder care, and even pet care. For example, some programs provide referrals and resources for dog walkers and local grooming facilities.

“We include referrals for these types of services, so employers are not spending too much time on the job trying to research services themselves,” Krehbiel says. “A contemporary EAP not only makes the services approachable and modern, but it also allows employees to access these and traditional EAP benefits in the way they prefer—via text, mobile app, online portal or phone.”

ACI's fastest-growing service is concierge services, “and this is where brokers are really letting money fall through the cracks,” she says.

Health care professionals working the overnight shift are one example of those who particularly appreciate concierge services for services that are normally closed at that time.

“It comes back to talent management,” Krehbiel says. “Many of these organizations are vying to be named on Fortune magazine's list of best places to work, and offering concierge services helps them get on that list. Employers really like specialty benefit providers that are technically savvy and are willing to integrate with other partners to create innovative solutions,” she adds.

HRAs

For employers with 50 to 350 employees, Cole Harris is a big proponent of health reimbursement arrangement, which is an alternative way of funding health plans.

“It enables first-dollar coverage before insurance kicks in, so you get more benefit up front,” says Harris, vice president of sales and marketing at CBIZ Benefits & Insurance Services of Tennessee in Knoxville. HRAs pick up a percentage of the doctor visit, say 80 percent, and employees pay the other 20 percent, he says. Parameters can be established to determine how the money in the HRA can be used within the medical plan that the employer provides. This enables the employer to be able to buy catastrophic coverage if they want to, but it works with any kind of medical plan.

Employers can fund the HRA by pulling money out of general assets, and they don't have a requirement to pre-fund, Harris says. The HRA is integrated with the medical plan, so the money never touches employee hands—employers pay the doctor and other vendors directly. Moreover, other non-insurance benefits fit in well with HRAs.

Harris says HRAs work especially well for organizations with 50 to 350 employees, because smaller organizations would get the metallic plans—bronze, silver and gold—that can't have HRAs, while for much larger companies, it makes more sense to be fully self-funded.

“We take more of a consultative approach to offering non-insurance benefits, based on what each client needs,” Harris says. “We also do a lot of human resource assistance for clients. For any HR-related issues, we can find certified HR professionals who can give an opinion on a letter-of-law question, or whether putting a certain social media policy or paid-time-off policy in a handbook is a good idea legally.”

Shifting control

Since the recession in the late 2000s, employers have been primarily focused on the bottom-line cost and taking whatever measures were necessary to manage their budgets, says Charlie Leatham, vice president at Hays Cos. in Minneapolis.

“Today, the pendulum of control shifts back towards employees due to the inverted pyramid of the workforce — not enough talent available to fill all types of positions held by retiring baby boomers,” Leatham says. “As such, employers are searching for creative ways to double down on the value of the benefits they offer to employees.”

From an employer perspective, non-insurance products don't carry the same risk as medical insurance, he says. These non-insurance products offer employees the services they need, including medial-related services, in a quick manner while keeping them productive at work.

Employers are trying to offset increasing out-of-pocket cost like copays, deductibles and out-of-pocket maximums, with programs that don't carry a lot of risks, but have great perceived value, Leatham says. Non-insurance products can range widely from critical illness, accident, and legal services, to home, auto and pet insurance, to transparency tools. In response to employer interest, Hays has launched a national seminar series on this topic.

One example of a transparency tool is Castlight, which allows people to research the cost and quality of medical procedures, such as a knee replacement, he says. Employers can also layer in additional tools, such as Best Doctors or Grand Rounds, which give people access to additional expert medical opinions on any diagnosis.

“These tools help drive better results and lower overall costs for both the employee and employer on the costliest plan participants,” Leatham says.

And medical tourism can take place either domestically or internationally, Leatham says. For example, if a member in California learns about a provider in Nevada that has good outcomes for back surgery, the employer can reduce the medical plan's deductibles or create incentives so the employee works directly with that provider. The plan might pay for the transportation and hotel in Nevada, so the family can go with the member.

There are many examples of companies that provide a bundled member specific concierge service that include telehealth and patient advocacy, among other services, he says.

“The goal of these bundles is to create claims substitution to a less costly setting while driving engagement through targeted communication,” Leatham says. “A win for the covered member and a win for the employer.”

Leatham is seeing much higher utilization rates with employers using a bundle as opposed to a medical carrier option or a standalone service. Brokers can either choose to include fees for the time and energy it takes to offer these services in their annual retainer to their clients, or waive some or all of the fees.

“The offerings do create stickiness for the broker-client relationship by providing value,” he says.

Depending on the specific program, these tools typically are priced based on subscription, Leatham says. The key to a successful program is to get employees to utilize the tools in order to help lower overall health care costs. “From a broker's perspective, our job is to provide consulting, compliance support and data analytics, but we can also educate our clients on industry trends and how to best engage employees,” he says. “Before we start making recommendations, we always listen to our clients, determine what challenges they may have, and collaborate on a plan to best overcome their challenges while saving money.”

Tech trends

Paradoxically, the advent of technology in the insurance space has introduced more non-insurance products, says Ben Bohonowicz, director of client services at Employee Benefit Services of Maryland Inc. in Baltimore. “Brokers are learning to creatively and consultatively leverage these non-insurance products to help fill gaps in coverage through time or cost savings,” Bohonowicz says.

While some of these products have been around for some time, they've primarily been offered in the large group market, he says. For example, telemedicine has existed for years, but only for large self-insured groups. “For the first time ever,” he says, “these previously unobtainable programs are being packaged together and rolled out to groups of all sizes. The overall program is affordable for employers or employees and there's plenty of broker compensation built in.”

He also believes that telemedicine as a service is quickly reaching the forefront of non-insurance benefits. Many groups are becoming self-insured and/or shifting towards high-deductible health plans, leaving the burden of cost back on the employer and/or employee.

“If we can introduce a service like telemedicine, which saves the employer and employees time and money, it's a win/win for all parties involved,” Bohonowicz says.

One service, called Healthiest You, aggregates many useful non-insurance benefits together “in a simple, easy-to-use” mobile application, he says. Healthiest You combines telemedicine, cost estimators, prescription cost comparisons, provider searches, and more. In some cases, depending on the carrier connectivity, subscribers can even see their current deductible utilization through the mobile app.

“There isn't always a one-size-fits-all for every group when it comes to offering these non-insurance benefits,” Bohonowicz says. “It all depends on the demographics of the group and the overall objective in offering these additional benefits.”

Benefit enrollment and admin systems have also made it much easier to roll these products out in addition to the core benefits, he says. Traditionally, face-to-face open enrollment meetings are held annually and the broker has one opportunity to roll out this huge menu of benefits.

“With this enrollment technology,” he says, “employees are introduced to an Amazon-like shopping experience for benefits where the entire family can enroll together on their own time when they have an opportunity to educate themselves on what's important to them.”

Other non-insurance products Bohonowicz and his firm have introduced include Kashable, which “helps employees to bridge the financial gap caused by out-of-pocket medical expenses, personal emergencies and times of hardship;” Care.com, a network of caregivers and businesses in child and senior care, pet care, housekeeping and tutoring; and GoodRx, which provides discounts on prescriptions.

Yet another example is Fixt, which provides phone and tablet insurance.

“These devices have become an increasingly integral part of the workforce,” Bohonowicz says. “When one breaks or becomes unusable, it can mean lost profits associated with productivity and delay.”

With Fixt, employees simply push a button and get a new phone in less than an hour for 50 percent of the cost and with full transparency to the company's information technology manager. The service is also less expensive than traditional device insurance offered through a wireless carrier.

Relationship building

“Offering non-insurance benefits is crucial to creating stickier relationships with my clients,” Bohonowicz says. “The most talented and competitive companies are always looking for ways to differentiate themselves to their prospective candidates.”

Brokers are given a unique opportunity to introduce human resource professionals to innovative and creative benefits that can make a difference, he says.

“It helps us remain a true partner in what's most important to them—attracting and retaining their employees,” Bohonowicz says. “Offering non-insurance benefits help establish our brand as a broker in being the forefront in solutions that bring value to our clients and their employees.”

Traditional Perks

• telehealth

• health advocacy

• discount vision

• nurses hotlines

• counseling services

• hearing aid benefits

• concierge services

• paid leave

• wellness programs

• child care

• elder care

• parking

• custom apparel

• specialty items

• corporate gifts

• 401(k) solutions

• travel discounts

• print & promotion swag

• web design

• payroll services

• dry cleaning

• roadside assistance reimbursement

• legal services

• student loans

• pet care savings

• employee discounts (hotels, theme parks, movies, theater, skip assets)

• FSAs

• relocation assistance

• transportation benefits

• prescription discounts

• smoking cessation

• tuition reimbursement

• adoption assistance

• employee assistance programs (stress reduction, family matters, substance abuse, crises intervention).

• company game rooms foosball, pinball, air hockey and Ping-Pong

• mailing packages

• sending flowers

• picking up and delivering groceries

• researching car insurance deals

• on-site day care center

• nutritional programs with counseling

• massages

• doggie day care

• paid sabbaticals

• drop-off laundry services

• recreation and fitness centers

• weight rooms

• billiards halls

• swimming pools

• running trails

• cell phone and TV discounts

• medical tourism savings networks

• I.D. theft assistance

• financial advice

• HRAs

• transparency tools

• cost estimators

• phone and tablet insurance

• chiropractic networks

• lifestyle programs

• medical bill negotiation services

• DNA tests

• coaching / positive development

• dog walker referrals

• medical procedure research

• compliance support

• data analytics

• prescription cost comparison tools

• medical provider searches

• tutoring networks

• housekeeping networks

Not Your Average Perks

• beer Fridays

• $100 monthly stipend to try alternative transportation options

• discounted scuba certification classes

• employee gardens

• changing the oil in employees' cars

• standing in line for concert tickets

• unlimited sick days

AMGEN

• pick up bouquets at the in-house gift shops

• takeout breakfast or lunch at the cafeteria

• on-site Lamaze

• breastfeeding classes

• lactation rooms

GOOGLE

• lunch, dinner and snacks from a choice of 16 gourmet cafes are free

• bring dogs to work

• free laundry machines

• four gyms

• on-site doctors

• new moms and dads expense up to $500 for takeout meals during the first three months they're home with their new baby

Genentech, Inc.

• seasonal produce stands in company cafeterias

• made-to-order sushi

• free cappuccinos

• two 24-hour libraries