Category: Interviews

Insurance Expert Question and Answer with Wellthie CEO and Founder, Sally Poblete

Shopping for insurance is difficult, but Sally Poblete, CEO and founder of Wellthie, is dedicated to modernizing the insurance industry for small businesses. With more than 20 years’ worth of experience, she has watched the health insurance industry develop and is keen to shake things up.

By Callie McGill, ValuePenguin, Inc.

Small-business owners are heavily involved in decisions regarding employee insurance plans (or lack thereof). That’s why innovators like Sally want to streamline the health insurance experience and allow small-business owners to focus on other aspects of the business. Wellthie’s platform enables small-business owners to view and compare medical, dental and vision products in various budget ranges. Then, at any point in the searching and shopping process, business owners can seamlessly connect with a licensed health insurance broker who can expertly guide them through purchasing and enrolling in the plan(s) of their choice.

ValuePenguin checked in with Sally about what inspired her to found Wellthie in 2013 and to learn more about her vision for the future. She sees small businesses in the United States as the lifeblood of our economy. These businesses drive the highest job growth and keep innovation alive and well. Small businesses are diverse and optimistic about the future—yet tremendously underserved when it comes to accessing health insurance options.

Many small-business owners don’t know the first thing about health insurance or whether they can even afford it. They have to use outdated processes when signing up, which can drag on for weeks. Wellthie is comprised of a team of insurance, technology and data experts who want to disrupt this norm to make health insurance more accessible to small businesses across the country.

Why it is hard to compare insurance services in the current way the insurance industry is set up?

The current processes require a lot of time, several in-person client appointments, emailing Excel spreadsheets back and forth, and a whole lot of phone tag.

However, in this digital age, consumers are not only accustomed to shopping online but often prefer it to other means of shopping. There is research which suggests that millennials are twice as likely to buy insurance online. Thanks to the technology provided by online health insurance marketplaces, agents and brokers can deliver a modern digital experience to their small-group clients, who favor digital experiences. This means offering their clients the freedom to browse and compare their own options on their own schedule.

How do you anticipate legislation to change the way the health insurance market currently works? What do you anticipate that meaning for small-business owners?

The current legislation provides some flexibility for business owners with fewer than 50 employees. However, these business owners can still choose to sponsor coverage and purchase fully insured (Affordable Care Act-compliant) plans.

Small businesses can also belong to professional employment organizations (PEOs) that offer payroll and HR services (in exchange for an administrative fee) in addition to health insurance. In certain states, there is also an option to participate in association health plans if you belong to a trade/industry group.

In addition to the above options, small businesses that are not ready to offer health insurance today can still encourage their employees to purchase individual health insurance.

What do you see as the biggest hurdle facing small-business owners when it comes to health care?

While small-business entrepreneurs are very knowledgeable in their line of work, they are not usually experts in insurance. It’s a complex subject and can be stress-inducing for these business owners, as they are often pressed for time and have tight budgets. Here’s what I see as the two biggest hurdles facing small-business owners when it comes to health care:

Knowing where to begin. For companies going through this process for the first time, it can be tough to know where to start. Creating a budget for health insurance. On average, the premium cost of a small-group plan (depending on the region of the country) is anywhere between $400 to $500 per employee, per month, which can really add up on an annual basis for a small company. Employers typically cover 50% or more of the total premium, while the employees cover the rest.

To keep pace with other innovative companies, how do you see health insurance and small-business behavior evolving in the future? What will Wellthie do continue to be at the forefront of innovation?

There is a lot of opportunity in building partnerships with companies, established or upstart, who are serving the same customers or offering related services and technologies. For example, we are working with other start­ups who are selling other types of insurance to small businesses and seeing how we can collaborate, and we are finding a lot of similar challenges and opportunities ­ so we can learn from other’s experiences.

In the coming year, our focus is to continue to refine the way we are marrying the digital experience with human experts. We are most excited about the partnerships we’ll be building, working with insurance players in the ecosystem, but also cultivating partners outside of the industry. Wellthie is actively pursuing partnerships with organizations that have a base of small businesses—payroll and co-­working companies, for example—and want to help their small businesses extend their vision into insurance and help their customers have an easier time finding insurance. We want to be that partner with them so we can scale more quickly.

What is the one health insurance concern that keeps you up at night?

I believe that most small businesses deeply care about their employees and want to support covering health insurance but are not yet able to do so because of cost. As an industry, we need to find more ways to create options for small-business owners at different price/value points.

Previously published at www.valuepenguin.com.

Interview with Wellthie advisor Jimmy Lee

Jimmy Lee
Wellthie Advisor, Jimmy Lee

In this interview, we sat down with Wellthie advisor Jimmy Lee to hear his thoughts on where the small group insurance market is heading. Jimmy is a dynamic healthcare visionary with extensive experience as a leader of several of Anthem’s multi-billion dollar divisions. He is currently a healthcare executive as CEO of SimpLee Healthcare, executive consultant with Sharecare, Advisory Boards of Wellthie and Solera Health, Board member and Treasurer of Easter Seals, and consultant for Pareto Intelligence and Leverage Health. Jimmy is the former President of the Small Group and Individual segments at Anthem, Inc, one of the nation’s largest health insurance companies.

What are the opportunities ahead for carriers to generate feasible growth in the small group market?

There is going to be a period of expanded options for small employers in terms of benefit offerings. Since ACA provisions went into effect in 2014, there have been strict regulations defining essential benefit offerings, community rating, rating relationships between metal products, elimination of industry and group size rating factors, and age rating restrictions. With those regulations loosening, we will see more variation in the types of plans available. For example, the recently announced rule to expand Association Health Plans may result in some lower rates on the market, though this will likely vary by state. There is also an opportunity for growth in ancillary offerings, wellness programs, and critical illness/accident coverage.

And obstacles?

Some states may be more restrictive than others in terms of how much variation they allow. However, carriers can offer both ACA-type plans and others as well. Short-term plans also present an obstacle because they can be extended to 12 months, which means we may see more individuals opting out of individual/small group ACA plans. Affordability is also a barrier because there are still small businesses who are unable to offer health plans due to costs. Carriers need to continue thinking about how to lower costs so that they can tap into small businesses who are not able to offer coverage today and thereby increase market size.

What should small group carriers be prioritizing in their growth strategy today?

Small group carriers need to be ready for the idea of increased choice. They should put additional investments into new product offerings, and from a sales and distribution standpoint will need to build new and different relationships. They should also be ready for more small groups choosing self-funded plans, an option that they have traditionally avoided. All of these changes will require a good actuarial understanding of the dynamics of the marketplace in order to arrange an effective product portfolio. Other considerations are the potential proliferation of Association Health Plans and MEWA benefit offerings.

How does the changing regulatory landscape affect small business insurance?

The current administration is not going to encourage or enhance the ACA; if anything, they will only try to dismantle it. However, they do want there to be more choice in terms of benefit offerings. From a broker standpoint, having more options to advise small businesses on will make them more valuable, since more choice will make it harder for small businesses to find the right solution. Business owners will need to rely on someone to give them advice, whether that’s a broker, consultant, navigator, or someone else.

What do you think will be the biggest disruptors in small group insurance in the next two years?

As providers are taking on more risk and different treatments and protocols are introduced, carriers are going to have to adapt in terms of where their value lies. Carriers need much deeper partnerships with providers in order to be successful in value-based models. We are seeing trends towards steerage of consumers to the most efficient providers and places of service based on cost and quality of care. Carriers are figuring out how to write medical policies so that members can get services in more convenient places and to push them towards the highest quality providers, all at the lowest possible costs.

Carriers also need to figure out how to engage members more effectively. They have been trying for years to get people to engage members by providing cost and quality transparency tools on their websites, but engagement is very low. They should be thinking about other ways to promote transparency and increase communication. We are also seeing more coordination of care, and Diabetes Prevention Programs (DPPs) are a prime example. DPPs are certified programs that work on behavior change to prevent people at high risk of developing diabetes. Finally, there is a heavy push towards addressing the social determinants of health. We know that income, housing, food insecurity, transportation, and many other social factors play a significant role in health outcomes. Carriers and providers that are able to target these determinants will best be able to lower costs and improve health outcomes.

What should a digital strategy look like for a carrier in health insurance?

Digital strategies can help carriers address some of the issues I just mentioned. Carriers should focus on developing mobile models that help steer people towards providers with the best results. They can also utilize technology to motivate people to engage in health-promoting behaviors, like getting a screening or exam or making lifestyle changes through involvement in a DPP. One big challenge for carriers is that members have many different engagement points, so those that can figure out how to manage all their care with one platform, integrate Electronic Medical Records with claims data, and identify gaps in care will be ahead of the market.

How is the relationship between InsurTech startups and incumbents evolving?

There is a definite possibility for these relationships to continue growing. InsurTech startups are identifying new ways to respond to issues quicker and cheaper than carriers do now, and these strategies can provide significant value to carriers. There is a specific opportunity around engagement tools that directly link providers and individuals to one another in large group plans. There are also opportunities in concierge tools, population health management, and risk adjustment that would be very useful to carriers.

How can carriers leverage data analytics in health insurance?

Carriers can leverage data analytics around managing existing members to identify the highest risk patients and take steps to improve their health. They should be digging deeper to understand what the gaps in care are for members and what they can do to prevent avoidable hospital visits. Carriers can also utilize data analytics to understand their members’ behaviors; for example, whether they are buying gym memberships or purchasing healthy foods, and prioritize which members to put their resources towards in terms of behavior change. Analytics can also help with benchmarking providers and understanding which ones have more or fewer gaps in care for members. Finally, insurers can use data analytics to gain more insights into how people make decisions about purchasing insurance.

How can carriers market better to millennial business owners?

Carriers first need to better understand millennial business owners as a business segment and figure out how they are different in terms of their needs and wants. For example, they may want more mobile services and personalized offerings than older customers. We also know Millennials are enthusiastic about dental benefits, even if they think they’re healthy enough to go without medical insurance. Once carriers identify these priorities, they should put in resources towards attracting and retaining Millennial consumers.

 

To learn how Wellthie can help carriers with these challenges, contact us today.