Next year will be a big one for design as more benefits advisors and employers break away from incremental additions and subtractions and begin to move in very new directions. (Illustration: Faye Rogers)

December is a month for celebration, reflection and expectation. We decided to leave the first two to others and focus on the year to come in five categories: technology, plan design, management, cost control and broker business.

We cast our net far and wide, soliciting our readers’ input on significant events and trends for 2019. We spoke with consultants, health care executives, benefits and HR managers, vendors and some who position themselves simply as seers. After culling the responses, we offer our best highlights of what’s to come in 2019. Thanks to all who participated. Once again, we were buoyed by your enthusiasm and thoughtfulness. Here’s to a great 2019!

Related: 6 economic predictions for the next 5 years

Technology: More work for machines, higher quality for humans

Insurance and health care held out against technology as long as they could, but once they came around, the marketplace was more than ready. The big trend for 2019 in health care will be telemedicine. Building on a strong showing in 2018, telemedicine is blockchaining its way throughout medical care and finding its way into most benefits packages as its applications increase. It’s facilitating better care for employees, where and when they want it. Onsite clinics, remote physician services, and mobile apps connecting patient to provider will all proliferate. Small businesses will unite to access such services.

“Telemedicine, particularly via mobile video, is on its way to becoming the standard for this generation,” says David Reid of EaseCentral, provider of an HR and benefits SaaS platform for insurance brokers.

Some see these technologies as eliminating certain roles—the insurance company’s, for instance.

“New technologies, including blockchain, are on the verge of enabling companies of all sizes to use smart contracts and other automation to administer plans,” says Dr. Jerry Beinhauer, MD, Founder and CEO of Appley Health. “By taking advantage of these advances, companies can remove insurance companies (and their high costs) from their health care equation. The gravy train will soon be pulling into the station.”

Meanwhile, artificial intelligence and its counterpart, machine learning, continue to find new applications in health care and insurance, performing the twin functions of stitching business activities together and simplifying them. Many new products driven by AI are targeting HR functions, such as recruiting and employee satisfaction surveying. Machines can do it better, their creators say—and some have the evidence to back up their claims.

Prognosticator Alex Burggren, enterprise sales director for channel partnerships at Virta Health, says, “AI and machine learning are buzzwords that get thrown around a lot, and in 2019 we’ll see more scrutiny on how these technologies are actually used and how they are making a difference in patient health and leading to longer-term engagement via technology.”

However, he cautions, watch for a bit of a backlash against all this AI and ML next year, as vendors get pushback from customers on products and services without clear and sustainable outcomes. “We are already starting to see focus shift toward full-stack health care companies that leverage technology as an important component, but not the only one,” he says.

Plan design: Don’t iterate the old plan, give me innovation

Next year will be a big one for design as more benefits advisors and employers break away from incremental additions and subtractions and begin to move in very new directions. Sure, there will still be some of the usual enrollment song-and-dance of an incremental increase of coverage costs to employers, followed by a “new plan” that often takes away yet more from employees. But employers, consumers and brokers are getting smarter faster, and 2019 will see another big shift toward plan design innovation.

Voluntary benefits’ inclusion will grow as plan design seeks customization to plan member needs. Susan L. Combs, of Combs & Company, predicts the emergence of more creative benefits, such as college loan repayment companies; the inclusion of loss of life advocates in plans to help those who have lost a family member but still need to remain present at work; and a greater range of benefits for females.

Wellness programs will be expanded where metrics support expansion or where they are seen as cost-effective. Marissa Costonis, a health change coach and author, says plans will focus more on health coaching, low-cost, on-site wellness practices such as massage, meditation rooms and desk-based workouts, and using healthy food as an incentive or reward to improve employee satisfaction and productivity.

Radical departures from the old ways will be on the rise, such as direct contracting for various services (primary care, mental health services, routine medical procedures); plans built to handle employer/provider partnerships; and new ways for managing pharmaceutical costs. Brokers at the cutting edge will be advising their clients on such plan designs, as more adopt the role of consultant and advisor rather than sales person.

Says Dave Chase of Health Rosetta: “I foresee a backlash against blunt-instrument high deductibles, creating an explosion of the ‘functionally uninsured’—that is, with more than 50 percent of U.S. households having less than $1,000 in savings and more than half of the workforce having a deductible greater than $1,000, millions of Americans are a bad stubbed toe away from financial ruin.”

PPO networks will decline, he predicts, as design follows two divergent paths: One toward narrow networks, the other a move away from traditional networks altogether—using either reference-based pricing or transparent open networks, the successor to PPO networks.

Management: Better data means better management skills will be required to survive

As plan design shifts rapidly, employers, health care system managers and brokers will need to develop new skills and think creatively to meet the demand for someone to manage these new arrangements. The driver: Better control over relevant data. As employers insist on more control over data, they are crunching it more effectively. Those who can master data management will soar.

The key here will be the rise of managers on the employer side whose role is to manage and understand their health care data and the cost components of their insurance and health care services. These new managers will be innovators, seeking the right partnerships that improve outcomes on the health side while reducing cost on the provider side. More companies will either have a Chief Medical Officer on staff or one on retainer to collaborate with brokers and providers. Here’s something else to keep an eye on for 2019: Health care supply chain management will become a profession. So says Nelson Griswold, president of agency-growth advisory Bottom Line Solutions, who serves as managing director of the NextGen Benefits Mastermind Partnership.

“This will be a new job description for employee benefit advisors,” he says. “Health care supply chain management is a brand new concept. This allows you to take a typical self funded plan based on hope and turn it into a high performing health plan because you are managing the costs. This is not about the lowest price. It is ensuring the highest quality at the lowest price.”

As these managers emerge, we will see formation of more creative employer/provider partnerships. Accountable care organizations and similar employer/provider partnerships will become popular as employers seek to reach into hospitals and clinics to force more accountability—and lower health care costs. Those who manage employee/health data will be tasked with analyzing it with a view toward matching the health care delivery system with what the data says is or is not happening.

On the health care side, providers will need to find the people who can respond to employer demands for improved outcomes. And brokers will need to steer more young talent into advisory and consulting roles, where they can truly form partnerships that employers will be demanding.

Chase adds an ominous 2019 challenge for employer-sponsored health plans: Legal risk concerns shifting from basic ACA compliance to lawsuits against employers. “There is a significant liability around fiduciary duty,” he says, indicating that both ERISA fiduciary duty and shareholder fiduciary duty could be highlighted. “In both cases, class action law firms have recognized that employers aren’t properly stewarding the resources that they are duty-bound to care for, as it’s so simple to cut spending by 20 percent or more using various proven cost containment tactics.

“The other employer legal risk is around opioids. So far, there are fifteen lawsuits filed against employers by surviving family members of employees who overdosed. As they dig into what happened to their loved one and see the extreme volume of opioids that the employer allowed to be prescribed, they are seeking to hold employers accountable for not flagging obvious abuse. As more plaintiffs and attorneys become aware of this, and with the extremely high volume of overdose deaths from prescription opioids, there’ll be a ramp up in 2019 accelerated by the public visibility of the umbrella opioid lawsuits/settlements against the opioid/pharma supply chain. This is now extending to employers.”

Cost control: Make it work better and cost less

In 2019, our crystal ball gazers say cost control will take new shapes and forms.

The big one here is also a management theme: Employer/provider partnerships, which, in early experiments, have slashed overall employer health costs dramatically. Some of the early adopters (Whole Foods in southern California, Walmart in Louisiana) sought to save money in part by eliminating insurers altogether from the relationship. As brokers begin to envision their role as connectors of the parties, they will validate their participation and be seen as cost-conscious and outcomes-focused rather than commission chasers.

Professional employer organizations (PEOs) may begin to consolidate, since too many were spawned in the last two years. “This past year we have seen a push for more of these companies popping up and the market is becoming very saturated, so I think we will see some consolidation here,” says Combs. But the concept will attract more employers as they understand the power in collaboration.

Certain products, services and processes will emerge in 2019 that are specifically designed to reduce cost. Some won’t contribute to better employee health or health coverage, like skinny plans a la Trump. But they will proliferate if legal conditions are right. Others will be marketed as triple-aim achievers, as more new products and services lay claim to immediate double-digit savings boosters.

Of course, not all will live up to their billing.

Meantime, at the large employer level, groups like the National Business Group on Health will continue to explore new pathways to better cost management. Among the items on their radar for 2019: half of employers (51 percent) identified implementing more virtual care solutions as their top health care initiative in 2019; 35 percent will have alternative payment and delivery models such as accountable care organizations (ACOs) and high performance networks (HPNs); and more employers said they will turn to direct contracting with health systems and providers and direct contracting between employers and centers of excellence (COEs) next year. The employers want to see better health outcomes for their spend, but they expect those to come at a lower cost. Next year will offer evidence for which strategies achieve that. The ones that don’t won’t be around long.

Broker business: Time to move into the 21st century

The big one here was discussed in BenefitsPRO’s November cover story, “Breakaway Brokers.” A total broker mindshift, from annual maintenance to annual overhaul and even “throw your plan out” strategies. The profile of the broker success stories of 2019 will describe the brokers’ transition from commission-based, limited-product service provider to year-round advisor/counselor who brings parties together to achieve mutually supportive objectives. Brokers that can’t bring these strategies to the employer will soon be out of business.

Meanwhile, to be able to move swiftly and stay relevant, many broker businesses need a technology overhaul, and that will be a theme next year as well. Last here is the increasingly painful short supply of top people needed to drive these new broker businesses. The talent battle will escalate.

Jason T. Andrew, CEO and founder of Limelight, a technology driven support system for brokers, says two of his top three 2019 highlights are tech-focused. “The insurance industry is not known for automation or AI,” he says. But there are a number of very interesting things taking place around both of these topics. For example:

1. The elimination of vast amounts of work now done manually as insurers finally accept the inevitability of automation and AI. “Allowing technology to take on some of the manual administrative tasks will enable all of us to focus on more important and strategic tasks that will provide for a much more meaningful and data-driven engagement in all facets of the interactions when rating, buying, selling and engaging with employee benefits.”

2. Greater internal connectivity through API will begin to streamline insurers’ back shops and front-facing customer service. “Currently, most carriers, brokers, and employers use multiple siloed systems. Because of this, you lose what would otherwise be a substantially simplified and meaningful workflow. We are seeing a growth in connectivity but we are at a very early stage.”

3. The battle for talent acquisition will escalate in 2019 as more brokers age out and others get out rather than adapt to the industry’s new demands. “Over the next few years, we expect up to 40 percent of licensed folks (the average age is 59) to retire. This presents a huge problem for our industry. Contrary to what many say, which is that brokers and agents will be disrupted by technology, I think we have the opposite problem: a massive shortage of qualified and licensed people coming into the industry.”

More insights into the year to come: 

• 4 trends in employee wellness programs for 2019
• 5 trends to expect in voluntary benefits in 2019
• Surprise! Medical costs will rise again in 2019