2020 Broker of the Year finalist: Adam Berkowitz

Adam Berkowitz started getting calls from his clients as soon as the COVID-19 shutdowns began. Many of them are in the retail and hospitality sectors, and layoffs of 90 percent to 100 percent of employees were common.

“It’s emotional when you lay off your entire workforce,” he says. “We are doing all we can to support them. Lots of employees need affordable insurance, and we’re helping them find it.” Berkowitz is watching as the pandemic exposes the shortcomings of many employer-sponsored health plans. The frustrating part? He knows a better way—and it already exists.

“We don’t need all these stimulus dollars; we need to spend what is there more wisely. We need to rethink how health care is being delivered. All the gaps in our system are exposed by the coronavirus outbreak. This is a stark reminder of just how broken our system is.”

Related: Unraveling the complexity of our health care billing system

Berkowitz is founder and president of St. Louis-based SimparaHR and was an early supporter and member of Health Rosetta. He has been rethinking health insurance for years. As his client base has grown, more employers are embracing the concept that their health care spend is an investment, not just a cost of doing business.

For Berkowitz, a career in insurance wasn’t necessarily a dream come true. When he graduated college, he saw it as a good opportunity that promised advancement and security. It wasn’t until he had a few years under his belt that he could see the possibilities for creative programs customized to his clients’ needs.

Just as insurance chose him rather than the other way around, so did entrepreneurialism. He lost his job in 2016, just as his wife went into labor with their first-born. Disillusioned by his employer’s insensitivity and awakened by the birth to all that he did not know about the health system, he determined to start his own shop.

“It was extremely risky. I could not have done it on my own,” he recalls. “But my wife was fully behind the move.”

With support at home and from his peers, SimparaHR began to thrive. The work he did for clients like Woodard Cleaning & Restoration showed his ability to turn an existing plan design into an investment tool for the employer and a usable health plan for the employee.

Lori Waggoner vividly remembers how Berkowitz turned health coverage on its head at Woodard, where the company had become increasingly frustrated with double-digit annual plan increases.

“The games, the refusal to bring creative options to the table, the lack of transparency around fees and costs, and the barriers to accessing our own data were all points we felt powerless to affect,” Waggoner says. “In spite of all that, we weren’t looking to make a big change this year and were hoping to explore alternative options on our own in preparation for a 2021 shift.”

But that timetable got suddenly pushed up earlier this year.

“Our carrier came back with a 37 percent increase in medical premiums on the back of last year’s 26 percent increase! We didn’t receive those numbers until 45 days before our plan was set to expire, but knew we had to do something drastic, and fast. That was only possible if we made radical changes.”

Woodard’s leadership cringed at the thought of further cost-shifting to its hardworking people. “Our primary short-term goal was to relieve the growing financial burden on our families. The escalation of premiums, high deductibles, and higher out-of-pocket expenses led to premiums that ate up as much as 28 percent of some of our folks’ income, with the OOP max potentially consuming as much as 72 percent!”

Waggoner took the challenge of finding an advocate the team could talk to. “I searched online for Rosetta brokers in St. Louis, not expecting to find anyone, but was surprised to discover Adam was in our very neighborhood!” she says. “I texted and immediately received Adam’s assurance that we had time to get a new plan in place before our enrollment.”

Since it was already mid-January, Waggoner was initially skeptical that Berkowitz could meet the April 1 deadline.

“Days later, he was in front of our executive team explaining what it would look like to walk, crawl, or run toward a new future. Based on Adam’s clear command of the industry and ability to articulate the gains and risks associated with change, we chose to sprint.”

The result: A self-funded package that included essentially no increase in premiums, along with a $0 deductible option for those who seek care within SSM Health Network, selected by the company as the primary health provider. Those who choose to go outside the network can do so, with increased copays and deductibles.

Waggoner said the company could not have asked for a better insurance partner. The short-term benefits to employer and employee were startling, and she anticipates steady gains over time.

“We avoided a 37 percent medical premium increase and a 16 percent dental premium increase. Over the next five years, we hope to realize additional gains through education that empowers our team to become smart consumers of quality health care services,” she says. “Adam has guided us through an enormous change in an incredibly truncated timeframe. In addition to his industry expertise, he’s tech-savvy, approachable, and he remains completely responsive to our needs.”

For Berkowitz, the pandemic not only exposes the flaws in the U.S. health system, but how many Americans are living on the edge.

“People who can’t afford a deductible also can’t afford to miss a paycheck,” he says. “If we can fix the health care system, we are addressing other economic problems at the same time.”