In short, Kim Jones is incorporating FMMA into group health plans and saving employers thousands. But, that’s not entirely what sets her apart.
Many people recognize brokers have a nice gig; guide and provide clients with the most appropriate health insurance policy. They are authorized by specific insurance companies to act on their behalf to help employers select a policy for themselves and their employees. Brokers earn revenue through commissions from the insurance companies.
Where Jones departs from the pack is her incorporation of the Free Market Medical Association and free market principals into group health plans. She believes the new paradigm helps employees get better care and employers save money.
Jones says, “We market to our clients based on the type of plan they want, their group size, and the plans available in the area. We can offer small group or fully-insured like United Healthcare and BC/BS. Employers pay a premium and get a product that has a network attached to it.”
Her expertise comes into play when employers are able to self-fund. Brokers are able to “get creative” and add free market providers to the mix.
She explains, “Self-funded employers own their plan; they are the sponsor. They pay a third-party administrator who keeps up with eligibility and claims. But, this is where we can be flexible. I gravitate to this kind of arrangement because integrating cash pricing and FMMA principles into health plans will save employers and employees a lot of money.”
A simple illustration of her new paradigm: An employee at Widget, Inc. needs a hernia repair. Using traditional health plans, the full cost at an in-network hospital, with network discounts, will be about $15,000; the employee will pay about $5,000 out-of-pocket for the deductible.
Because Widget, Inc.’s broker is Kim Jones, when the employee calls to discuss options, Jones is able to suggest alternatives; one of which is a free market surgery center. These centers publish a cash price that is all-inclusive and that same surgery costs about $3,200.
As well, free market services are rendered by providers who typically have better outcomes than larger facilities.
A self-funded employer can offer the employee a choice; if the employee chooses the cash pricing, they may reduce that deductible to $2,000 or waive it completely because free market is saving the company money too. Some employers even pay the travel expenses to and from the surgery center.
When self-funded, CEOs are free to incentivize employees in this way to choose the free market center for its price transparency and the cost savings across the board.
“The incentive for employees is simple. Cash pricing is about an 80 percent reduction in cost; if the employee goes with the premier provider, that saves the company money and they can afford to waive everything.”
She recommends this type of plan for any size company, although it may not be a good fit for everyone. “We have to look at the employee pool. It is not best for a group that may have high attrition or a percentage of employees with more serious needs; e.g., cancer, or heart disease.”
Jones says she does her best to get the right third-party administrator into the mix as well. With self-funding and free market, when employers call in for a pre-authorization, the TPA may redirect and find out if the employee would be interested in the big hospital with the big deductible or the free market system and have the bill paid for them. “This gives people the choice and it’s a good thing,” she says. “Employees become consumers in their own health care.”
Jones says it’s not just about the health care; her mission is also to create transparency in her own business. “A lot of brokers don’t understand that they are supposed to disclose what they are being paid. As a free market advocate, working to promote and encourage price transparency, I, too, want to be sure that my clients know from where and how much I am being paid for the services I provide.”
Jones stays involved with employee groups and shares information via employee meetings and payroll slips. “We are not making recommendations on their care, just giving them all the options regarding where and how they can receive it in order to keep their costs down.”
She also shares her expertise with other brokers and says her only concern is that things won’t change and we will end up with a single-payer system. “When I give talks to broker groups and employers, I can see them leaning in. I always encourage them to get in touch with a local FMMA chapter, have a buy-in and listen to free market providers to understand why they are different. Many employers are incorporating these providers into their plans and waiving ALL out-of-pocket costs for employees.
“Costs are out of control and this information is too good to keep to ourselves. Once that is done, I work on the realization that brokers need to help customers rather than make more money. We have to care about people more than profit.”
Jones says she is a firm believer that things need to change. “Employers needs to start shopping differently for their programs and putting buyers in touch with sellers of healthcare. This cuts out the high-dollar, pulled-out-of-the-air PPO pricing. It’s too complicated for the average person to wade through so most people just accept it.”
She says it is a challenge to make everyone fit into the mold but believes large companies have no reason not to participate. “They have a fiduciary responsibility to make sure the prices they are paying are accurate and fair, especially if costs are being passed on to the employee.”
Jones’ bottom line is Just. Make. The. Call. “Most people will be surprised. So many of us get our insurance from our employers and, as the broker, or middle man, I am committed to getting it right for the consumers. I’m on their side.”