I was born to do this: A Q&A with Christina King

Paul Wilson: How did you get started in the benefits industry?

I moved to Central Ohio in early 2000 and was offered an opportunity at a benefits agency. I was an accidental agent, just like most in the industry. Right away, I loved it. I remember my boss telling me that I was a natural and that I was born to do this. From the beginning, I was passionate about what we were doing.

I worked for other agencies, and watched what they did well and what they did poorly. I saw them make decisions based on overrides and bonuses from insurance companies, rather than considering the best interests of their clients, so I started to become frustrated. My husband, who has always worked in venture capital, said, “I don’t know why you’re giving 60% to 75% of everything you make to someone else. Why don’t you go out on your own?” I was scared, because I was used to selling behind an agency name, but I decided to take the leap and started C&A out of my home. I had clients who followed me over the years, so I knew many of them would probably follow me as I went out on my own. I started with a dozen clients or so.

I started C&A during a recession, probably not the best timing, but anytime there’s chaos, there’s opportunity. I remember talking to another business woman and saying, “When I started working with you, you had 17 employees; now you have 75. How did you do it?” She said, “Listen to your clients’ pain and figure out how to fix it.”

When the recession came, most businesses downsized their HR departments; during tough times, HR is often one of the first departments to get hit. So we were often working with a business owner or office manager, or HR duties were passed down to somebody in finance. And they usually hated it! At that time, we were working primarily with small groups, so I decided to start a payroll company. As advisors, we never knew when employees were eligible for benefits and we were always getting calls like, “Hey, Bob has been here six months and I don’t think we’ve offered him benefits yet.” Or worse, Bob had been gone for six months and no one alerted us to turn off his benefits. No one ever forgets to turn off the payroll, so I thought if we had payroll, someone is hired, we completely onboard them, get them set up with benefits, payroll deductions, and do all their compliance requirements. And that really took off. When someone left, we’d do that for clients and keep them compliant.

I had 10 clients sign up before I even had a Federal ID number for the new company. They loved the concept. As a business owner myself, I always think, “Would I pay for that?” That’s really accelerating again right now, because many small and mid-sized businesses are hiring remotely. Maybe for the first time, they have an employee in Utah or New Jersey and they’re not sure what to do. We help them with benefits, payroll and things like handbooks, training, and employee issues. So we developed an HR support service, too.

Providing all these services shows that we’re not just a commodity; it’s a true partnership. We also have a Medicare expert on staff who helps older employees who are looking to transition. We really do full service.

PW: How has that journey shaped your philosophies and who you are today?

When you’re new to the industry, you often get raised by the insurance companies. You come in like a piece of clay and they take you out and teach you how to sell their products. And you just think this is how it works.

I’ve always questioned things. “Why does it have to be this way?” Earlier on, I often heard “Don’t move business from this carrier, because it’s going to ruin our bonus or our overrides.” Or “Don’t do this, even if you can save the client money.” And that didn’t sit well with me. If you were a small client, you didn’t get attention because we were always looking for big revenue. We wanted to charge more and do less for clients. I don’t work in the status quo part of the industry anymore, but that was the mindset. They wanted clients that would be low maintenance, so we could collect commissions and then go find another one.

When I started C&A, our core values were always based on the best interests of our clients. Always do the right thing, even if it costs you money up front, because it will pay off in the long run.

I remember when I started, employers would often say, “I didn’t know you were out there.” And that used to get me fired up, thinking I needed to spend a lot of money on marketing. But I often wasn’t big enough for the marketing companies I talked to. That always bothered me and motivated me to never treat my clients that way. I can’t tell you how many times companies call and say, “Hey, my friend in business told me about you. I only have 10 employees so I’m probably not big enough for you.” But that’s simply not true; those businesses often need us more to help them navigate. And over time, I’ve learned that they’ll tell everyone else they know about you and sometimes they have friends with large groups; other times, they grow and stick with us. If you do the right thing, it will usually pay off.

Our first clients are still part of our family; it’s important for clients to think of us as their partners and not just that we’re there to sell them health insurance.

PW: How has the growing and evolving role of the C-suite in benefits conversations impacted your conversations and strategies with clients?

The CEO and CFO are definitely involved in more of our conversations these days, along with VPs of Procurement. There are often a variety of stakeholders sitting around the table. If a client has an HR department, we are here to support them; if they don’t, we often become their HR department in a number of ways. We support them, but we’re never there to replace them.

When we’re talking to the CEO and CFO, of course they’re always looking at EBITDA and the bottom line. I love showing them where they have overspent in their plans and ways we can fix it. But ultimately, the CEO really wants to know what employees are going to experience. “What does this mean for my people?” There’s a misconception that only HR worries about that, but CEOs are often just as invested.

There are so many resources available now and so much data and we’ve done a really good job of breaking that down and saving our employers millions of dollars. But ultimately, if the employees are confused or disrupted, we’re going to get fired. They don’t care about the money when they have a workforce up in arms.

I’ve learned to sometimes take baby steps: “Here’s one area we can fix to start. And here’s how it will impact your employees and how we can educate them about it.” I’ve learned to move them along, because everybody wants a better health plan, they don’t want to spend a bunch of money, but we don’t always do enough to explain what they chose and how it’s going to impact everybody. So I’ve learned to do it more softly.

PW: What are the different opportunities and challenges when working with smaller employers on innovative strategies like self-funding?

I love self-funding; that’s where I focus my time and my effort. We started primarily in small group and still have clients with one employee. But our largest client has about 5,000 employees, so there’s different industries and group sizes. The data is so important, because on fully insured and some self-funded plans, you’re getting information about what has already happened. We meet with groups monthly and have conversations about trends, how we can impact what’s going to hit the health plan and be more proactive. That’s the part I love about self-funding—not having to have that conversation with an employer about what already happened. Having that visibility is key.

I wrote my first self-funded small group in 2010. At that time, the employer had 25 employees on the plan and everyone was telling me I was crazy. But I saw value in what we could bring them. Many employers I talk to are getting 19% increases, 33% increases, and they don’t know why. It’s all about popping the hood, seeing what’s going on and determining what we can truly impact. One of the things we have to overcome is when I talk to employers, whether they have 50 employees or 1,000, and they say, “We tried self-funding before and it didn’t work. It failed miserably.” Self-funding is just a financial strategy; it’s only the first step. You also need to put in cost containment strategies. You’re going to have a year where it won’t work as well and you’ll have to make changes to manage it better. It’s not just about taking somebody self-funded, but how we can then impact what they’re spending.

PW: What types of tools and strategies are you focusing on right now to cut costs and improve quality?

We always look at the costs of specialty medications; how much mark up we’re seeing on the pharmacy side when a client is fully-insured. We’ve been doing reference-based pricing for several years and I’ve been surprised at how many hospital systems would agree to our pricing and not balance bill. We do have some that aren’t so friendly, but when presenting them with the data, I was surprised how many said “thank you” and took the money. But the more we work nationally, the more I’m seeing hospital systems that are starting to push back on that.

My goal for 2023 is to work on direct contracts with hospitals. When we do these alternate funding plans, we often want to shine a light on hospitals as the villains, but we forget there are good doctors, nurses and executives out there who want to do the right thing. And I’m having really good conversations with hospital execs who say, “Our vision is changing. We’re not building towers anymore; we want to be in the community.”

I’ve spent a lot of time talking with them about how health care is not sustainable. We can’t continue with the chargemaster and costs going up every year. It takes a lot of time to get some hospital execs to understand that insurers aren’t the payers — it’s the employers. A lot of times, hospital systems say, “We’re not giving bigger discounts because XYZ carrier will just make more money and it’s going to cut into our margins.” But we’re having conversations about how the insurers don’t necessarily need to be involved; we’re doing direct contracting with hospital systems because these employers are important to our community. We’re gaining a lot of momentum because of that.

PW: How are conversations about change and innovation going? Are you getting more buy-in? Has economic turmoil made employers more or less open to change?

It’s a marathon when it comes to education. A few months back, I talked to a group of CEOs, smart people in our community, and they were angry because they knew something was wrong with their plan and they were spending too much, but no one had taken the time to talk to them and explain what they should be questioning in their health plans. It’s a slow process. You hear, “Well if that were true, why hasn’t anyone mentioned it before? Why didn’t my big brokerage share this with me?” There’s a lot of back and forth; it takes time.

But I’m really excited about where our industry is going. There are going to be some remarkable changes in the next few years. Many who would not have made changes in the past or were reluctant to upset the apple cart are looking at things differently and saying, “I’m going to start questioning where my money is going.”

PW: How do you stay motivated and not get discouraged?

We’re making a difference; I see the impact that we’re having on how people are receiving care, what they’re paying out of pocket and how we’re impacting the bottom line. It’s more work; it’s harder. There will always be brokers who want to get paid and do less work and just jump from carrier to carrier. This is a long-term strategy; I would love for it to go faster, but I wake up every day and say “I get to do this; not I have to do this.”

PW: Finish this sentence: The key to success in this industry going forward is…

People. If we don’t have good people and work to help others, we’re never going to truly change our industry. I love listening to people’s stories, looking them in the eye and asking them, “How can I help?” That goes a long way.