Hello, all you Relentless Tribe members. Thanks for hanging with me today to talk about a bunch of things. One of them being what exactly are level-funded plans, and what are the upsides, and then what are the risks?
Because here's the thing. I was talking to an employer the other day, an employer with a fully funded insured plan; and he told me his renewal this year: 69% … 69%!
For a full transcript of this episode, click here.
If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe.
Now, their broker managed to negotiate that increase down to 50%. I'm not entirely sure if I'd classify that as a victory. So, when Frank Pennachio says in the conversation with him that I'm gonna have today that there's a lot of desperation out there for a lifesaver for these plan sponsors, for employers out there, for just a way forward that may just even preserve the employer's ability to continue to provide coverage; to not actively be working insanely hard to try to replace the humans with, like, AI that doesn't need insurance; or to, like, offshore labor to a country, literally any other country, because any other country is going to have more affordable healthcare, like, at a certain point, one more double-digit increase, one more 50% increase becomes a really big corporate decision.
So, right, we talk a lot about self-funding on Relentless Health Value because it can be a very empowering way to go if a plan sponsor chooses to embrace the entirety of the potential upsides while mitigating the inherent risks of becoming a fiduciary and, as Elizabeth Mitchell has said, running a small insurance business off the side of their desks.
That's what you're doing when you become self-insured. Someone in the company is running a small insurance business off the side of their desk.
What would be a problem for anyone to hear, though, is a message that self-funding or becoming a self-insured employer is, like, some kind of homogenous broad stroke.
Like, all of these employer-sponsored insurance companies that have gotten stood up are the same or maybe even similar, kind of forgetting that there are many, many different flavors or models of self-insurance.
So, coming up here, Frank Pennachio, my guest today, quotes economist Thomas Sowell, who famously said that in healthcare, "There are no solutions. There are only trade-offs." And you can see why, because all of this adds up to a key point: how plan sponsors can make intentional and intelligent decisions, trade-offs, pick which trade-off they want rather than desperate ones.
So, right, my guest today is Frank Pennachio, who is the author of the book The Silent Danger. Frank brings nearly 40 years of experience in the health insurance industry. He started his career on the P&C (property casualty) side before evolving into employee benefits, owning an agency, consulting, and training with agencies and plan sponsors nationwide.
Frank also has a couple of courses available on his Web site, so certainly do check them out.
In the conversation coming up here, Frank walks us through the hidden contract risks that level-funded plan sponsors fall into regularly; and then we get into the critical takeaways to help plan sponsors, their advisors, navigate these waters with eyes wide open.
If you are an employer considering, for example, level funding or trying to figure out other ways to be self-funded or an advisor or a policymaker or anybody thinking hard about healthcare affordability and where the dollars spent by taxpayers, members, and health plans are going, this episode is your essential field guide.
This is Relentless Health Value. I want to first of all thank Frank for generously offering to sponsor the costs of producing this episode, which was really kind of him. That was a really nice gesture.
Also, thanks to our founding sponsor, Aventria Health Group. And with that, here is my conversation with Frank Pennachio.
Also mentioned in this episode are Elizabeth Mitchell; Aventria Health Group; Andreas Mang; Jon Camire; Kimberly Carleson; Justin Leader; Lori Guliano; David Goldfarb; Doug Aldeen; Cynthia Fisher; Claire Brockbank; Stan Schwartz, MD; and ZERO.health.
For a list of healthcare industry acronyms and terms that may be unfamiliar to you, click here.
You can learn more at thesilentdanger.com and by following Frank on LinkedIn.
Frank Pennachio is a nationally recognized authority on fiduciary risk, ERISA compliance, and the governance of self-funded health plans. With more than four decades in the insurance and risk management industry, Frank has built a reputation for challenging conventional thinking and exposing hidden liabilities that often go undetected in employer-sponsored benefit programs.
Frank is known for connecting silos that traditionally operate independently: employee benefits and property & casualty.
Frank is the author of The Silent Danger, a book focused on the overlooked fiduciary risks embedded in self-funded health plans and the structural weaknesses that leave plan sponsors vulnerable. He has trained thousands of insurance professionals and developed comprehensive fiduciary training programs used by agencies and organizations nationwide.
00:00 Introduction to this episode.
03:37 An overview of today's conversation.
04:57 What level funding is.
06:20 Why level funding is having an explosion in popularity.
08:03 What does an employer need to take into account when considering level funding?
09:36 The first risk of level funding.
12:24 The second risk of level funding.
14:07 EP478 and EP479 with Andreas Mang and Jon Camire.
14:41 LinkedIn post by Kimberly Carleson.
14:50 LinkedIn post by David Goldfarb on stop-loss cost trends.
15:01 The third risk of level funding.
19:45 The fourth risk of level funding.
21:46 The fifth risk of level funding.
24:14 EP457 with Cynthia Fisher.
24:41 Actionable strategies when considering level funding.
27:34 Survey by Kaiser Family Foundation.
33:30 A summary of advice for level funding.
34:08 EP453 with Claire Brockbank.
34:31 EP433 with Justin Leader.
Recent past interviews:
Click a guest's name for their latest RHV episode!
Chris Klomp, Evan Anderson, Jake Velie and Keith Hartman, Dr Eric Bricker, Yashaswini Singh, Mark Cuban and Cora Opsahl, Dr Cristin Dickerson
NOTE This file was generated by Descript
00:00:00 --> 00:00:02 Hello, all you Relentless Tribe members.
00:00:02 --> 00:00:07 Thanks for hanging with me today to talk about a bunch of things.
00:00:07 --> 00:00:14 One of them being what exactly are level-funded plans, and what are the
00:00:14 --> 00:00:16 upsides, and then what are the risks?
00:00:18 --> 00:00:19 Because here's the thing.
00:00:19 --> 00:00:22 I was talking to an employer the other day, an employer with a fully
00:00:22 --> 00:00:30 funded insured plan, and he told me his renewal this year, 69%.
00:00:30 --> 00:00:31 69%!
00:00:31 --> 00:00:37 Now, their broker managed to negotiate that increase down to 50%.
00:00:39 --> 00:00:42 I'm not entirely sure if I'd classify that as a victory.
00:00:43 --> 00:00:48 So when Frank Pennachio says in the conversation with him that I'm gonna have
00:00:48 --> 00:00:55 today that there's a lot of desperation out there for a lifesaver for these
00:00:56 --> 00:01:02 plan sponsors, for employers out there, for just a way forward that may just
00:01:02 --> 00:01:07 even preserve the employer's ability to continue to provide coverage, to
00:01:07 --> 00:01:12 not actively be working insanely hard to try to replace the humans with,
00:01:12 --> 00:01:19 like, AI that doesn't need insurance, or to, like, offshore labor to a
00:01:19 --> 00:01:23 country, literally any other country, because any other country is going
00:01:23 --> 00:01:25 to have more affordable healthcare.
00:01:25 --> 00:01:29 Like, at a certain point, one more double-digit increase,
00:01:29 --> 00:01:34 one more 50% increase becomes a really big corporate decision.
00:01:35 --> 00:01:40 So right, we talk a lot about self-funding on Relentless Health Value because it
00:01:40 --> 00:01:46 can be a very empowering way to go if a plan sponsor chooses to embrace the
00:01:46 --> 00:01:52 entirety of the potential upsides while mitigating the inherent risks of becoming
00:01:52 --> 00:01:58 a fiduciary and, as Elizabeth Mitchell has said, running a small insurance
00:01:59 --> 00:02:02 business off the side of their desks.
00:02:02 --> 00:02:05 That's what you're doing when you become self-insured.
00:02:05 --> 00:02:09 Someone in the company is running a small insurance business
00:02:09 --> 00:02:10 off the side of their desk.
00:02:11 --> 00:02:15 What would be a problem for anyone to hear, though, is a message
00:02:15 --> 00:02:19 that self-funding or becoming a self-insured employer is, like, some
00:02:19 --> 00:02:21 kind of homogenous broad stroke.
00:02:21 --> 00:02:25 Like, all of these employer-sponsored insurance companies that have gotten
00:02:25 --> 00:02:32 stood up are the same or maybe even similar, kind of forgetting
00:02:32 --> 00:02:37 that there are many, many different flavors or models of self-insurance.
00:02:39 --> 00:02:44 So coming up here, Frank Pennachio, my guest today, quotes economist Thomas
00:02:44 --> 00:02:48 Sowell, who famously said that In healthcare, "There are no solutions,
00:02:48 --> 00:02:53 there are only trade-offs." And you can see why, because all of this adds up to
00:02:53 --> 00:02:59 a key point, how plan sponsors can make intentional and intelligent decisions,
00:03:00 --> 00:03:06 trade-offs, pick which trade-off they want rather than desperate ones.
00:03:07 --> 00:03:11 So right, my guest today is Frank Pennachio, who is the author
00:03:11 --> 00:03:13 of the book, The Silent Danger.
00:03:13 --> 00:03:18 Frank brings nearly 40 years of experience in the health insurance industry.
00:03:18 --> 00:03:22 He started his career on the P&C, the property casualty side, before evolving
00:03:22 --> 00:03:26 into employee benefits, owning an agency, consulting, and training with
00:03:26 --> 00:03:28 agencies and plan sponsors nationwide.
00:03:28 --> 00:03:33 Frank also has a couple of courses available on his website, so
00:03:33 --> 00:03:34 certainly do check them out.
00:03:35 --> 00:03:37 Link in the show notes, as always.
00:03:37 --> 00:03:42 In the conversation coming up here, Frank walks us through the hidden contract
00:03:42 --> 00:03:50 risks that level-funded plan sponsors fall into regularly, and then we get
00:03:50 --> 00:03:54 into the critical takeaways to help plan sponsors, their advisors, navigate
00:03:54 --> 00:03:56 these waters with eyes wide open.
00:03:56 --> 00:03:59 If you are an employer considering, for example, level funding or
00:03:59 --> 00:04:03 trying to figure out other ways to be self-funded, or an advisor or a
00:04:03 --> 00:04:07 policymaker or anybody thinking hard about healthcare affordability and
00:04:07 --> 00:04:12 where the dollars spent by taxpayers, members, and health plans are going, this
00:04:12 --> 00:04:15 episode is your essential field guide.
00:04:15 --> 00:04:16 I'm Stacey Richter.
00:04:16 --> 00:04:18 This is Relentless Health Value.
00:04:18 --> 00:04:22 I want to first of all thank Frank for generously offering to sponsor
00:04:22 --> 00:04:26 the costs of producing this episode, which was really kind of him.
00:04:26 --> 00:04:28 That was a really nice gesture.
00:04:28 --> 00:04:32 Also, thanks to our founding sponsor, Aventria Health Group.
00:04:33 --> 00:04:36 And with that, here is my conversation with Frank Pennachio.
00:04:37 --> 00:04:40 Frank Pennachio, welcome to Relentless Health Value.
00:04:40 --> 00:04:41 Thanks for having me, Stacey.
00:04:41 --> 00:04:42 It's a pleasure to be with you today.
00:04:43 --> 00:04:50 So before we discuss the actions to be taken such that a plan can
00:04:50 --> 00:04:55 confidently move forward with a level funding, self-funded option, or maybe
00:04:55 --> 00:05:01 decide not to- A legit question here, Frank, is what is level funding?
00:05:01 --> 00:05:02 So maybe we should start there.
00:05:02 --> 00:05:03 Let's start there.
00:05:04 --> 00:05:08 So the name level funding indicates that the plan sponsor's gonna pay
00:05:08 --> 00:05:10 in a level amount every month.
00:05:11 --> 00:05:14 It may not be the ultimate amount they pay, but they're gonna pay
00:05:14 --> 00:05:15 in a level amount every month.
00:05:15 --> 00:05:20 And if their claims experience is positive, is good, they have an
00:05:20 --> 00:05:26 opportunity to get a return of that money at the end of the policy period.
00:05:27 --> 00:05:31 It's a hybrid between the way the cash flows.
00:05:31 --> 00:05:35 It feels like a fully insured plan to the plan sponsor 'cause I'm
00:05:35 --> 00:05:37 paying my, my amount every month.
00:05:37 --> 00:05:44 But ultimately, it is self-funding, and it carries the, the risks
00:05:44 --> 00:05:45 and the benefits of self-funding
00:05:46 --> 00:05:52 Just to reiterate, it feels comfortable for some plan sponsors who may be
00:05:52 --> 00:05:57 used to a fully insured model because they're told , "This is your nut that
00:05:57 --> 00:06:00 you're gonna pay every single month," and, and then you get a, the, the
00:06:00 --> 00:06:02 invoice, and you pay that amount, right?
00:06:02 --> 00:06:04 So it's, you can count on this number.
00:06:05 --> 00:06:09 Then there's the opportunity for the surplus that which is often mentioned.
00:06:09 --> 00:06:13 But to your point, it is actually a form of self-funding.
00:06:13 --> 00:06:16 So from that vector, it's not a hybrid.
00:06:16 --> 00:06:19 It is squarely self-funding.
00:06:19 --> 00:06:20 Absolutely.
00:06:20 --> 00:06:23 Why, why now for level funding?
00:06:24 --> 00:06:26 There's been a, kind of an explosion here.
00:06:27 --> 00:06:27 Why?
00:06:28 --> 00:06:30 Well, there's this relentless cost increase.
00:06:30 --> 00:06:34 2027 is gonna be probably the worst we've seen in, from what
00:06:34 --> 00:06:35 I understand, over a decade.
00:06:36 --> 00:06:37 There's desperation.
00:06:38 --> 00:06:41 There's desperation among plan sponsor employers.
00:06:41 --> 00:06:42 There's desperation among agents.
00:06:42 --> 00:06:45 People are looking for, there must be a way to stem the tide
00:06:45 --> 00:06:47 on these increasing costs.
00:06:47 --> 00:06:52 So there's, there's, even if employers of all sizes are looking at level
00:06:52 --> 00:06:56 funding, which let's say right up front, level funding is self-funding.
00:06:57 --> 00:07:00 It may, we'll talk a little bit about this as we go through, it
00:07:00 --> 00:07:04 may appear to act very much like a fully insured plan, but it is not.
00:07:04 --> 00:07:11 It is a self-funded plan, and the pressure is on to, in some way, endeavor
00:07:11 --> 00:07:16 to mitigate these ever-increasing costs for employers and employees.
00:07:16 --> 00:07:20 Desperation from the standpoint of everybody.
00:07:20 --> 00:07:22 You mentioned employee benefit consultants.
00:07:22 --> 00:07:28 You mentioned brokers who are looking for a real solution for their clients
00:07:28 --> 00:07:34 who are facing these cost increases, which can be astronomical, double
00:07:34 --> 00:07:35 digits, year after year after year.
00:07:35 --> 00:07:39 It's like the opposite of compounding interest in your savings account.
00:07:39 --> 00:07:46 Like, it's a thing, and level funding, as you said, it is a form of
00:07:46 --> 00:07:52 self-funding, which has its upsides and its things that you have to make
00:07:52 --> 00:07:59 sure that you are mitigating for all the reasons that self-funding is both
00:07:59 --> 00:08:02 excellent and also a responsibility.
00:08:03 --> 00:08:09 If you're an employer and you're considering level funding, what are
00:08:09 --> 00:08:12 these things that need to be buttoned up?
00:08:12 --> 00:08:18 So the first step is… My objective is fairly simple.
00:08:18 --> 00:08:24 I just wanna help agents and advisors, help plan sponsors to make intentional
00:08:24 --> 00:08:27 and intelligent decisions as to whether these plans are right for them.
00:08:28 --> 00:08:30 There are trade-offs.
00:08:30 --> 00:08:34 As, as Thomas Sowell, economist, says, "There are no solutions.
00:08:34 --> 00:08:35 There are just trade-offs."
00:08:35 --> 00:08:35 There's trade-offs.
00:08:35 --> 00:08:39 There's upside, there's downside, there's potential to reduce the cost.
00:08:39 --> 00:08:44 There's also a potential that you could have greater cost and greater liability.
00:08:44 --> 00:08:48 So the key is to help people understand that, those trade-offs.
00:08:48 --> 00:08:51 What are they, what are they potentially going to gain, and what are they
00:08:51 --> 00:08:56 potentially have to lose by entering into one of these types of plans?
00:08:57 --> 00:08:59 And I hear you, because knowledge is power, right?
00:08:59 --> 00:09:06 Like, if we are aware of these potentials on both sides, then we
00:09:06 --> 00:09:10 can take advantage of the potential upsides while also mitigating for the
00:09:10 --> 00:09:14 downsides, and that's the way that you wanna move forward, with intention.
00:09:14 --> 00:09:16 I like how you put that.
00:09:16 --> 00:09:22 I don't necessarily mean to focus on risks, but let's focus on risks
00:09:22 --> 00:09:27 so that we can lay them out and then figure out how we're going to address
00:09:27 --> 00:09:32 them such that upsides are upsides and there's as few downsides here that we
00:09:32 --> 00:09:35 can accidentally fall into as possible.
00:09:36 --> 00:09:41 What would, what would be your first risk to, to get addressed here?
00:09:41 --> 00:09:44 I would say the first risk is, is the moment you, a plan
00:09:44 --> 00:09:46 sponsor signs a contract.
00:09:46 --> 00:09:50 Let's say it's the third-party administration claims administration
00:09:50 --> 00:09:53 agreement or an ASO agreement, administrative services only agreement
00:09:55 --> 00:09:59 Typically, they are signing contracts that have embedded in them ERISA violations,
00:10:00 --> 00:10:04 and typically they do not have an ERISA attorney on their side to negotiate and
00:10:04 --> 00:10:10 to mitigate those clauses so that they're not signing on to an ERISA violation
00:10:10 --> 00:10:11 the moment they sign the contract.
00:10:12 --> 00:10:16 And that's first and foremost it's let's… Because ERISA violations,
00:10:17 --> 00:10:22 Stacey, carry a potential of personal asset exposure, and we want to
00:10:22 --> 00:10:24 mitigate those as much as possible.
00:10:24 --> 00:10:29 I'm not gonna assert that you're going to ferret out everything out of the contracts
00:10:29 --> 00:10:33 that you want and that you're gonna get exactly what you want, but we do want to
00:10:33 --> 00:10:40 negotiate and not sign contracts as is, so the plan sponsors have an opportunity
00:10:40 --> 00:10:45 to push back against what have already been deemed by some federal courts to be
00:10:45 --> 00:10:48 ERISA violations that we're seeing the clauses still remain in the contracts.
00:10:49 --> 00:10:51 Level funding is a form of self-funding.
00:10:52 --> 00:10:52 Yes.
00:10:52 --> 00:10:58 And we have had multiple guests on this show talking about the fact that
00:10:58 --> 00:11:03 once you start self-funding, then you become the fiduciary of the plan,
00:11:03 --> 00:11:05 and this is, this is no different.
00:11:05 --> 00:11:07 It's, it is a form of self-funding.
00:11:07 --> 00:11:13 So best practices would apply for any, just, just the same
00:11:13 --> 00:11:17 as anybody else seeking to do self-funding or doing self-funding.
00:11:17 --> 00:11:21 One of them is make sure you have your own, for example, ERISA attorney.
00:11:21 --> 00:11:26 Because as multiple guests have said multiple times on this show, there are
00:11:27 --> 00:11:31 these buried Easter eggs, I'm, the, don't know what you call them, in, in
00:11:31 --> 00:11:33 the contracts where there was just…
00:11:34 --> 00:11:38 I think it was the Tiara Yachts lawsuit where there was a fiduciary issue
00:11:38 --> 00:11:41 with the contract, and the vendor was like, "Well, you're the one that
00:11:41 --> 00:11:45 signed it. You shouldn't have signed it if you knew that you were gonna be
00:11:45 --> 00:11:47 in breach of your fiduciary duties."
00:11:47 --> 00:11:47 Right?
00:11:47 --> 00:11:50 So, like, at the end of the day, it's kind of buyer beware.
00:11:50 --> 00:11:54 And I've, I've been involved in some of those conversations where
00:11:54 --> 00:11:57 the comment back is, "Well, your, your fees do not meet the prudent
00:11:57 --> 00:12:00 test under ERISA." Not my problem.
00:12:00 --> 00:12:03 I'm not the fiduciary, and I didn't sign the contract.
00:12:03 --> 00:12:09 So that's, that is, uh, technically correct, but quite disconcerting to
00:12:09 --> 00:12:10 engage in a conversation like that.
00:12:11 --> 00:12:14 Be very careful when you sign these contracts.
00:12:14 --> 00:12:20 If I was gonna talk about a second risk here, so we just talked about kind
00:12:20 --> 00:12:23 of this, there is a fiduciary shift and, and we should be aware of it.
00:12:23 --> 00:12:27 What's your, what's your second main risk factor?
00:12:27 --> 00:12:31 I would say there's frequently a misalignment between the plan, which
00:12:32 --> 00:12:36 again, are the promises that the plan sponsors make into the employees.
00:12:36 --> 00:12:40 You're gonna get these benefits irrespective of whether or not I get
00:12:40 --> 00:12:42 reimbursed from the stop loss or not.
00:12:43 --> 00:12:48 And frequently, the plan promises are not in alignment with the stop loss.
00:12:48 --> 00:12:49 And I'll give you just a quick example.
00:12:49 --> 00:12:52 We could go through dozens of them, but a quick example
00:12:52 --> 00:12:53 is the eligibility provision.
00:12:54 --> 00:12:57 The eligibility, you're eligible to be on this plan and get these promises
00:12:57 --> 00:13:03 made to you if you work 30 hours a week, if you're on FMLA or COBRA.
00:13:03 --> 00:13:07 Typically, that aligns with the stop loss, but sometimes plan sponsors
00:13:07 --> 00:13:11 will go further if you're on approved leave or they extend the eligibility
00:13:11 --> 00:13:15 in the plan, but it doesn't line up with the, with the stop loss.
00:13:15 --> 00:13:19 And we can go down a whole series, Stacey, of where promises are made
00:13:19 --> 00:13:23 under the plan that are not gonna be reimbursed under the stop loss.
00:13:23 --> 00:13:25 And when that happens, guess who's on the hook?
00:13:26 --> 00:13:27 The plan sponsor employer's on the hook.
00:13:28 --> 00:13:30 Oh, you don't have the cash flow in your company to pay that?
00:13:31 --> 00:13:33 Well, now we're going to personal assets.
00:13:33 --> 00:13:36 And, and that's where we have to be very careful.
00:13:36 --> 00:13:40 I've even discovered some managing general agencies, they're selling
00:13:40 --> 00:13:43 stop loss having never seen the plan.
00:13:43 --> 00:13:46 There's no connection whatsoever to the plan.
00:13:46 --> 00:13:47 This is not health insurance.
00:13:47 --> 00:13:48 This is self-insurance.
00:13:48 --> 00:13:53 The plan sponsor's gonna pay, and most of the time, the stop
00:13:53 --> 00:13:55 loss reimburses as expected.
00:13:55 --> 00:13:59 But there are certainly areas where there's misalignment that can be fixed
00:14:00 --> 00:14:06 Yeah, and long time listeners or even short time ones are probably also going
00:14:06 --> 00:14:12 to remember, there was a show last year with Andreas Mang and Jon Camire where
00:14:12 --> 00:14:18 we talked about just the issue of stop loss misalignment with the plan, which
00:14:18 --> 00:14:24 again, is more than just, happens with more than just level funding, but because
00:14:24 --> 00:14:29 level funding is a form of self-funding, and this is kind of a self-funding issue.
00:14:30 --> 00:14:33 Same absolute rules apply.
00:14:34 --> 00:14:39 So right, as I just said, listen to the two-part show.
00:14:39 --> 00:14:41 This is episode 478 and 479.
00:14:41 --> 00:14:46 I will also link to a recent post by Kimberly Carleson with great
00:14:46 --> 00:14:50 comments by Justin Leader and Lori Guiliano on this exact topic.
00:14:51 --> 00:14:58 I will also link to another post on stop loss cost trends, by David Goldfarb.
00:14:58 --> 00:14:59 Again, links in the show notes.
00:15:01 --> 00:15:04 What do, what do you have for me for, for risk three?
00:15:05 --> 00:15:11 Level funding, one of the big promises is you have an opportunity
00:15:12 --> 00:15:15 to get money back out of a surplus fund, what's called a surplus fund.
00:15:16 --> 00:15:16 You have a chance.
00:15:17 --> 00:15:23 And the way it typically works is you pay your monthly allotment in, claims
00:15:23 --> 00:15:27 are paid up to your deductible, the stop loss pays the claims in excess of
00:15:27 --> 00:15:29 deductible when everything goes well.
00:15:29 --> 00:15:35 And the idea is, based on what you've paid in, if after those things occur, the
00:15:35 --> 00:15:38 intention is you get surplus returned.
00:15:38 --> 00:15:44 Now, you have to look closely at the surplus formula, because I've seen
00:15:44 --> 00:15:49 plans and Stacey, I don't want to assert that what I'm about to say
00:15:49 --> 00:15:53 applies to every single level funding plan out, level funded plan out there.
00:15:53 --> 00:15:53 No.
00:15:53 --> 00:15:56 But I've seen plans that operate this way.
00:15:56 --> 00:15:58 Yes, I paid my money in.
00:15:58 --> 00:15:59 Yes, I paid claims up to the deductible.
00:15:59 --> 00:16:02 Yes, the carrier's picked up over the deductible.
00:16:02 --> 00:16:08 But then a carrier may apply what's called an incurred but not reported factor and
00:16:08 --> 00:16:13 take that factor, many times it's not even actuarial-based, actuarially-based,
00:16:14 --> 00:16:16 take it out of the surplus.
00:16:17 --> 00:16:21 Then they may also take a quote unquote "service fee", I've seen as high as
00:16:21 --> 00:16:26 thirty percent Well, they've already charged for all the services, but
00:16:26 --> 00:16:27 then they're gonna take a service fee.
00:16:27 --> 00:16:30 So we got claims coming out, we got incurred but not reported factors coming
00:16:30 --> 00:16:34 out, we got service fees coming out, and oh, by the way, if there's anything
00:16:34 --> 00:16:39 left, you need to be with us five years down the road because when we return any
00:16:39 --> 00:16:45 surplus that may be left, it's returned as an invoice credit, not as a check, which
00:16:46 --> 00:16:50 that, in and of itself, you're committing that I need to be with you, with this
00:16:50 --> 00:16:54 carrier, five to six years down the road, or, or I… even if I've qualified
00:16:54 --> 00:16:57 for a surplus, I'm not gonna get one.
00:16:57 --> 00:17:03 So risk three here, I'm gonna do the thing I did with r- risk one and risk two.
00:17:03 --> 00:17:08 It's specific to level funding, but it's also kind of a universal fact
00:17:08 --> 00:17:11 of life over here in the healthcare industry in the United States.
00:17:12 --> 00:17:17 So what you basically said for risk three is, watch it with the surplus.
00:17:17 --> 00:17:17 Right.
00:17:17 --> 00:17:21 Because what might be written on, similar to, like, PBM contracts.
00:17:21 --> 00:17:25 The first two pages tell you what you wanna hear, basically,
00:17:25 --> 00:17:28 and then the remaining 150 tell you why that's not gonna happen.
00:17:30 --> 00:17:32 So it kind of almost sounds like the same thing.
00:17:32 --> 00:17:38 What everybody kind of would love to get at the end of the time is a, the
00:17:38 --> 00:17:40 surplus back, the overpayment back.
00:17:40 --> 00:17:43 But what you're saying is, watch it.
00:17:43 --> 00:17:47 Read the back half of the contract because there could be language in there
00:17:47 --> 00:17:50 that says, as you said, that it's not just like, "Oh, here's the surplus.
00:17:50 --> 00:17:55 Here you go." It's like, um, you know, manufacturer rebates and PBM contracts.
00:17:55 --> 00:17:57 There's just this pot of money.
00:17:57 --> 00:17:57 Right.
00:17:57 --> 00:17:59 And did we classify it as a rebate?
00:17:59 --> 00:18:01 Did we classify it as a surplus?
00:18:01 --> 00:18:02 Oh, no, it's actually a service fee.
00:18:02 --> 00:18:06 Oh, no, it's actually a incurred but not reported, right?
00:18:06 --> 00:18:08 Like, they'll come up with a different name.
00:18:08 --> 00:18:10 Now it's not a surplus, and now you don't get it.
00:18:10 --> 00:18:13 And it, additionally, with a lot of these contracts, and I see point
00:18:13 --> 00:18:19 solution contracts that are the same way, where it's not actually dollars back.
00:18:19 --> 00:18:22 It's a credit some years hence.
00:18:22 --> 00:18:28 So again, this, this particular instance is relevant to level funding plans,
00:18:28 --> 00:18:31 but it's a common term that you'll see in some of these contracts, sadly.
00:18:32 --> 00:18:34 What we're trying to do with the intentional and intelligent
00:18:34 --> 00:18:38 decision-making process is weigh this risk and reward.
00:18:38 --> 00:18:44 There's a risk and reward ratio, and if you're… We know that level funded
00:18:44 --> 00:18:49 plan sponsors are assuming greater risks for the potential of a reward.
00:18:49 --> 00:18:50 That's the way it works.
00:18:50 --> 00:18:53 That's the way it's embedded into the whole product.
00:18:53 --> 00:18:55 It's the plan sponsor's decision.
00:18:55 --> 00:18:59 We're just looking to help them be more aware and, and have
00:18:59 --> 00:19:00 all the transparency laid out.
00:19:00 --> 00:19:01 Here are your risks.
00:19:01 --> 00:19:03 Here's your potential reward.
00:19:03 --> 00:19:06 We know you're, we, we know you're under a lot of pressure with the increases.
00:19:07 --> 00:19:11 Let's take a look at it and make sensible decisions, especially,
00:19:11 --> 00:19:15 especially when ERISA allows personal assets to be exposed.
00:19:16 --> 00:19:20 To that end, it's not only a message like read the fine print
00:19:20 --> 00:19:21 at the end of the contract.
00:19:21 --> 00:19:25 It also might be a message like, hmm, maybe do the math, like without that
00:19:25 --> 00:19:29 surplus included or, you know, like there's a lot of I think, very valuable
00:19:29 --> 00:19:33 takeaways that, that are kind of coming up here as we're going through these
00:19:33 --> 00:19:38 risks to just ensure that this plan is gonna work the way the plan sponsor wants.
00:19:38 --> 00:19:42 And again, upsides are taken advantage of and downsides are
00:19:42 --> 00:19:44 at least known knowns going in.
00:19:44 --> 00:19:44 Right.
00:19:45 --> 00:19:46 How about a number four?
00:19:46 --> 00:19:47 Do we have a number four here?
00:19:47 --> 00:19:48 We do.
00:19:48 --> 00:19:54 The fourth risk is frequently touted in self-funded plans, level-funded and
00:19:54 --> 00:20:00 self-funded plans, is greater claims data transparency, and that's a promise
00:20:00 --> 00:20:07 that is made upfront and pretty much with every offer And that's only true
00:20:07 --> 00:20:15 if the plan sponsor doesn't sign away their opportunity to secure that claim
00:20:15 --> 00:20:18 data in the manner in which they choose.
00:20:18 --> 00:20:23 And frequently what happens is, once they sign the contract, that claim
00:20:23 --> 00:20:28 data access and transparency gets so restricted that the plan sponsor really
00:20:28 --> 00:20:30 doesn't get what they were promised.
00:20:30 --> 00:20:35 And claim data transparency now is, it should be a given.
00:20:35 --> 00:20:37 I mean, with, with the new laws coming out and the new litigation
00:20:37 --> 00:20:41 emerging, there should be no question as to who owns the data.
00:20:41 --> 00:20:43 The plan sponsor owns the data.
00:20:43 --> 00:20:48 The plan sponsor must have access to the data in order to have any
00:20:48 --> 00:20:50 opportunity to reduce claim costs.
00:20:50 --> 00:20:56 Yeah, again, long time and probably short time listeners are like, "Hmm, this,
00:20:56 --> 00:20:59 this song sounds very familiar," right?
00:20:59 --> 00:21:06 It's just such a common through almost every self-insured, self-funded plan
00:21:06 --> 00:21:10 working with especially ASOs or certain…
00:21:10 --> 00:21:17 There's, there's certainly some TPAs that are well known for not providing
00:21:17 --> 00:21:23 data, which to your exact point, the Consolidated Appropriations Act, both
00:21:23 --> 00:21:28 the 2021, I think, and as clarified in 2026, like it is the plan sponsor's data.
00:21:28 --> 00:21:29 The plan sponsor should get it.
00:21:29 --> 00:21:30 And they've signed it away.
00:21:30 --> 00:21:32 They've signed the rights away when they sign the contract.
00:21:33 --> 00:21:34 Yeah.
00:21:34 --> 00:21:36 Sadly, that is quite common.
00:21:37 --> 00:21:41 Not amongst our listeners who are at least aware of it at this
00:21:41 --> 00:21:45 juncture, but it's harder than it looks on TV to get those crossed off.
00:21:45 --> 00:21:48 So risk five, where are we?
00:21:48 --> 00:21:51 Well, we go back to, you just mentioned the Consolidated Appropriations
00:21:51 --> 00:21:54 Act of, we had '21, 2021 and 2026.
00:21:54 --> 00:21:58 So, so if listeners are going, "Well, wait a minute, you know, I've been in
00:21:58 --> 00:22:00 this plan," well, new things are emerging.
00:22:00 --> 00:22:02 I mean, give yourself some grace here.
00:22:02 --> 00:22:05 We have a, we have a new law just a few months ago that went into effect.
00:22:05 --> 00:22:09 But the biggest issues here go to what you just mentioned, Stacey, and
00:22:09 --> 00:22:14 that's more around the transparency of not just the broker's fees.
00:22:14 --> 00:22:19 That came in 2021, now expanded to all service providers because the
00:22:20 --> 00:22:24 plan sponsor, the fiduciaries, must pay what are known as prudent fees.
00:22:24 --> 00:22:25 They don't have to be the lowest fees.
00:22:26 --> 00:22:27 They have to be prudent.
00:22:27 --> 00:22:30 They have to be defended as being able to be prudent.
00:22:31 --> 00:22:36 And when you dig into these contracts, once again, ask yourself, "Can I defend
00:22:36 --> 00:22:42 in the bright light of day a $50 bill to reprice one hospital bill?"
00:22:43 --> 00:22:48 I've seen a TPA contract where As they say in the South, bless your heart,
00:22:48 --> 00:22:53 the most you're gonna charge me is $50 to reprice one hospital bill.
00:22:53 --> 00:22:55 That is indefensible.
00:22:55 --> 00:23:00 And if, when and if the time were to come, either an audit or it arises
00:23:00 --> 00:23:04 through litigation, the plan sponsors can be told to put that money back.
00:23:05 --> 00:23:07 It's not your money, it's the participant's money,
00:23:07 --> 00:23:08 and put that money back.
00:23:08 --> 00:23:09 Oh, you don't have it?
00:23:10 --> 00:23:13 Again, we're gonna start attaching personal assets.
00:23:13 --> 00:23:19 So disclosure of all fees, and then benchmarking.
00:23:19 --> 00:23:22 Again, you don't have to be the lowest, but you have to be in the ball game.
00:23:22 --> 00:23:25 You have to be able to defend what are considered prudent.
00:23:26 --> 00:23:27 What would a prudent person do?
00:23:28 --> 00:23:32 How would a prudent person pay fees for all these various critical,
00:23:32 --> 00:23:34 necessary, important services?
00:23:34 --> 00:23:37 And we want our vendors and we want our professional service providers
00:23:37 --> 00:23:41 to be profitable so they can invest in the best technology and hire
00:23:41 --> 00:23:46 the best people, but you can't, you can't pay fees that are excessive.
00:23:46 --> 00:23:51 The definition of fiduciary is fees have to be reasonable, prudent, and free of
00:23:51 --> 00:23:53 conflict, I think are, are the three
00:23:53 --> 00:23:54 kind of top line.
00:23:55 --> 00:24:00 And again, similar to every other self-funded plan, level funding
00:24:00 --> 00:24:06 being a flavor of a self-funded plan, all these same rules apply.
00:24:06 --> 00:24:07 Absolutely.
00:24:07 --> 00:24:12 Doug Aldeen actually was on the pod a couple of months ago talking about
00:24:12 --> 00:24:15 exactly what you're just saying, like, the $50 repricing fee.
00:24:15 --> 00:24:19 We had Cynthia Fisher on talking about the, it was, like, a $600
00:24:20 --> 00:24:21 out-of-network example, right?
00:24:21 --> 00:24:24 Like, these are all kind of examples of, of the same thing, so
00:24:24 --> 00:24:27 it's not like we're talking about changing the couch cushions here.
00:24:27 --> 00:24:30 Like, this, this can be s- significant dollars.
00:24:30 --> 00:24:35 All right, five risks that are avoidable, actually.
00:24:35 --> 00:24:37 You, you take the time and the effort, and you go through this
00:24:37 --> 00:24:40 carefully, and these are avoidable.
00:24:41 --> 00:24:42 What's your advice?
00:24:42 --> 00:24:46 Like, if I am really thinking to myself, I really actually do want
00:24:46 --> 00:24:53 to avoid these risks, how would you kind of distill this down into maybe
00:24:53 --> 00:24:57 like action items or strategies here.
00:24:58 --> 00:25:03 Well, the first thing I would, I would do is I would engage with an ERISA attorney.
00:25:03 --> 00:25:06 You're assuming, the plan sponsors are assuming significant risks.
00:25:06 --> 00:25:11 I can promise you that anybody on the, any vendor or carrier on the
00:25:11 --> 00:25:15 other side of the table, they have attorneys crafting these contracts.
00:25:15 --> 00:25:19 And, and look, it's their duty and responsibility to shift as much risk
00:25:19 --> 00:25:21 over to the plan sponsor as possible.
00:25:21 --> 00:25:23 That's just the way the game works in our system.
00:25:24 --> 00:25:28 So we need to level the playing field and say, okay, we need
00:25:28 --> 00:25:29 to push back and negotiate.
00:25:30 --> 00:25:32 Never sign a contract as is.
00:25:33 --> 00:25:36 That would be, I think, probably a… I think that's a strong
00:25:36 --> 00:25:39 statement, but I would, I would assert that it's good advice.
00:25:39 --> 00:25:40 Not as is.
00:25:40 --> 00:25:46 Because as is pushed much more liability over, and risked to the plan sponsors.
00:25:46 --> 00:25:48 Understand what this is about.
00:25:48 --> 00:25:51 We have multitude, as I mentioned, of contracts.
00:25:51 --> 00:25:53 You have the plan itself, which is a contract.
00:25:53 --> 00:25:54 You're making all these promises.
00:25:54 --> 00:25:56 You've got the claims administration.
00:25:56 --> 00:25:59 You've got quite, you know, you've got the stop loss.
00:25:59 --> 00:26:01 You've got quite possibly either a network contract or a
00:26:01 --> 00:26:03 reference-based pricing contract.
00:26:03 --> 00:26:04 Go read the contracts.
00:26:05 --> 00:26:06 And it's complex.
00:26:06 --> 00:26:10 The opportunities, yes, are there, but plan sponsors have to make a
00:26:10 --> 00:26:14 far greater commitment of time, energy, money, and investment in
00:26:14 --> 00:26:15 order to make this work for them.
00:26:16 --> 00:26:22 The first takeaway that I heard you say is, number one, right now, go get an
00:26:22 --> 00:26:26 ERISA attorney if you're considering moving, especially if you're moving from
00:26:26 --> 00:26:33 fully insured to a level funded or a type of self-funding of any nature, really.
00:26:33 --> 00:26:36 Like start out, that's your first item on the list.
00:26:36 --> 00:26:38 Get a, get an attorney to help you here.
00:26:39 --> 00:26:40 That's number one.
00:26:40 --> 00:26:44 The second kinda takeaway that's sort of implicit and, and I think what you
00:26:44 --> 00:26:52 just said there is, really educating everyone involved in the plan on what
00:26:52 --> 00:26:55 self-funding means and just sort of all, what are all of the different
00:26:55 --> 00:27:00 contracts that are gonna be coming in, really reading them, understanding
00:27:00 --> 00:27:02 how they all add up, fit together.
00:27:03 --> 00:27:07 An ERISA attorney would certainly help here, but just making sure that
00:27:08 --> 00:27:14 those who are on the plan sponsor side, who are tiptoeing or charging
00:27:14 --> 00:27:19 in this direction, have a bead on what this whole thing actually means,
00:27:19 --> 00:27:22 especially, as you said, the owners of the company or the fiduciaries,
00:27:23 --> 00:27:25 whoever's signing that document does have some personal liability here.
00:27:26 --> 00:27:28 These kinds of things are just really important to go in with
00:27:28 --> 00:27:29 eyes wide open, it sounds like.
00:27:30 --> 00:27:31 There's no doubt.
00:27:31 --> 00:27:36 And, and what we're finding, too, uh, the Kaiser Family Foundation, and
00:27:36 --> 00:27:40 their new survey will be out likely in October, usually comes out every
00:27:40 --> 00:27:46 October, but the last survey they put out, they estimate that 44% of employers
00:27:46 --> 00:27:54 with nine to 49 employees, nine to 49 employees, are self-funded, which m- that
00:27:54 --> 00:27:55 group's gonna be mostly level funded.
00:27:56 --> 00:27:59 Now, you're probably gonna get pushback from a nine-employee firm, "I'm gonna
00:27:59 --> 00:28:05 hire an ERISA attorney?" Well, just, you know, we strongly encourage that
00:28:05 --> 00:28:07 you do, because you have the same risks.
00:28:07 --> 00:28:12 And for all practical purposes, the plan sponsor is now the insurance company.
00:28:13 --> 00:28:17 They buy stop loss much like an insurance company buys reinsurance.
00:28:17 --> 00:28:19 There's my promises to my employees.
00:28:19 --> 00:28:21 I have to deliver on them.
00:28:21 --> 00:28:22 I am the insurance company.
00:28:22 --> 00:28:26 Yes, I have stop-loss, and yes, I have, service providers to assist me with
00:28:26 --> 00:28:32 this, but I am, I am it, and I would not want to assume that liability and
00:28:32 --> 00:28:37 that responsibility without professional support from an ERISA attorney.
00:28:37 --> 00:28:42 As mentioned, the other side has attorneys, and why would you wanna
00:28:42 --> 00:28:44 go to that negotiation without one?
00:28:45 --> 00:28:46 Yeah, for sure.
00:28:46 --> 00:28:52 Level funding certainly has some advantages, right, over other forms of
00:28:52 --> 00:28:56 self-funding if an employer is smaller, but it is still a form of self-funding.
00:28:56 --> 00:29:00 I, I heard a quote the other day, "The marketing is theater. The truth
00:29:00 --> 00:29:02 are the contracts and the data."
00:29:02 --> 00:29:03 Well said.
00:29:04 --> 00:29:04 Well said.
00:29:04 --> 00:29:09 So, you know, another thing that I'm kind of thinking of here as you're
00:29:09 --> 00:29:15 talking is, and maybe I'm gonna chalk this up as our third takeaway, as you
00:29:15 --> 00:29:23 said, not all of these level funding purveyors, vendors are the same.
00:29:24 --> 00:29:30 So it definitely would appear that one should shop around and be looking at
00:29:30 --> 00:29:35 the actual contracts while doing so, not just, like, comparing PowerPoint
00:29:35 --> 00:29:36 presentations, it sounds like.
00:29:37 --> 00:29:38 Absolutely.
00:29:38 --> 00:29:41 I don't think a proposal… And yes, shopping around, there's,
00:29:41 --> 00:29:45 there's a number of managing general agencies that are in the game now.
00:29:45 --> 00:29:46 It's not just, not the carriers.
00:29:46 --> 00:29:48 The carriers were, were the ones that really pretty much
00:29:48 --> 00:29:50 launched this many years ago.
00:29:50 --> 00:29:54 But there's other programs available, and they're programs that basically
00:29:54 --> 00:29:59 can be bundled together with a stop-loss here and claims administrator
00:29:59 --> 00:30:01 over there and a PBM over there.
00:30:01 --> 00:30:02 And, and there's some advantages to that.
00:30:02 --> 00:30:04 There's some significant advantages to that.
00:30:05 --> 00:30:08 But somebody's gotta coordinate it all, and somebody's gotta make sure
00:30:08 --> 00:30:13 that when, when it's bundled, that that bundle is, is in alignment and
00:30:13 --> 00:30:16 each piece is carefully examined.
00:30:16 --> 00:30:21 There's a, a sundry of opportunities out there, and it's not my intention at all
00:30:22 --> 00:30:26 to do anything more than help people make better decisions and get that risk-reward
00:30:26 --> 00:30:32 ratio clear to everybody who may be taking, choosing to take greater risk.
00:30:33 --> 00:30:33 Right.
00:30:33 --> 00:30:37 Okay, so takeaway advice three is think about all the things that you've heard
00:30:37 --> 00:30:47 today, and do your RFPs really look at any given vendor very carefully with respect
00:30:47 --> 00:30:51 to everything that we've talked about, along with probably that ERISA attorney.
00:30:51 --> 00:30:51 Right.
00:30:52 --> 00:31:00 You know, I think another, again, takeaway that I'm kind of hearing here is
00:31:01 --> 00:31:12 pick a broker or EBC who also has aligned interests with you, the plan sponsor.
00:31:12 --> 00:31:16 And again, this is not the first time, nor will it be the last
00:31:16 --> 00:31:17 time that this has come up.
00:31:17 --> 00:31:21 But there's similarly to just we, we were talking about with the vendors,
00:31:21 --> 00:31:25 the level funding vendors themselves, there are some fantastic brokers and
00:31:25 --> 00:31:31 EBCs out there who have made a commitment to working on behalf of the plan.
00:31:31 --> 00:31:34 Their pricing is that way, all the documents.
00:31:35 --> 00:31:36 So Stacey, we're seeing a divide.
00:31:36 --> 00:31:41 We're seeing, there are certainly the agents, brokers, and consultants
00:31:41 --> 00:31:45 out there that are telling you the things that we're talking about today.
00:31:45 --> 00:31:46 They're raising the awareness.
00:31:47 --> 00:31:48 They're illuminating the risks.
00:31:49 --> 00:31:54 The rewards, you know, certainly can be there And there are those that are not.
00:31:54 --> 00:31:57 There are those that are still just saying, "Come with me and
00:31:57 --> 00:32:00 I'll, I can help you reduce your costs. I can help you fight back
00:32:00 --> 00:32:01 against these escalating costs."
00:32:02 --> 00:32:06 If the risks are not being discussed, I would be very cautious.
00:32:06 --> 00:32:08 I'd be very careful.
00:32:08 --> 00:32:11 And sometimes people push back at me and say, "Well, that's scare tactics."
00:32:11 --> 00:32:16 It's not scare tactics, it's the reality of what we're dealing with here.
00:32:16 --> 00:32:17 We have a crisis.
00:32:17 --> 00:32:19 There's no doubt there's a crisis.
00:32:19 --> 00:32:21 So how do we address this crisis?
00:32:21 --> 00:32:24 Well, we, we don't pull the covers up over our head.
00:32:24 --> 00:32:29 We let the light in and help people make intelligent, informed decisions.
00:32:29 --> 00:32:37 I mean, it, it, there's a difference between a broker EBC who, again, is
00:32:37 --> 00:32:43 trying really, really hard to satisfy a client's objective, maybe desperate
00:32:43 --> 00:32:46 need to figure out how to control costs.
00:32:46 --> 00:32:48 There's two ways to proceed from that, you know.
00:32:48 --> 00:32:55 One is to lead a client down a path which ultimately they're not quite
00:32:56 --> 00:33:00 informed about, and then kind of wind up with a worse problem than
00:33:00 --> 00:33:07 the one they started with because the broker EBC has the trust and wasn't
00:33:08 --> 00:33:09 maybe informed enough themselves.
00:33:09 --> 00:33:13 Like, I don't necessarily wanna even portray any maliciousness here.
00:33:13 --> 00:33:17 It could just be they're not really well informed about the, you know, all
00:33:17 --> 00:33:18 the things that we just talked about.
00:33:19 --> 00:33:23 But relative to a plan sponsor, I think it's pretty clear here that
00:33:23 --> 00:33:28 a really informed EBC will be going through with the plan sponsor all
00:33:28 --> 00:33:30 the stuff that we talked about today.
00:33:30 --> 00:33:33 All right, here's the advice summarized.
00:33:33 --> 00:33:35 One, never sign a contract as is.
00:33:35 --> 00:33:38 Get aforementioned ERISA attorney involved.
00:33:38 --> 00:33:43 Second piece of advice, plan sponsor team is, in fact, running a small insurance
00:33:43 --> 00:33:45 company off the side of their desk.
00:33:45 --> 00:33:47 That is what self-insured means.
00:33:47 --> 00:33:51 So make sure that everyone on the plan sponsor side really truly gets
00:33:51 --> 00:33:55 that this is what's happening and is educated to be an informed fiduciary
00:33:55 --> 00:33:59 decision-maker commensurate with this level of responsibility for the plan.
00:33:59 --> 00:34:04 Piece of advice three, recognize that not all level funded plans are equal,
00:34:04 --> 00:34:07 and spend the time to do a legit RFP.
00:34:08 --> 00:34:12 Do listen to the episode with Claire Brockbank on RFPs.
00:34:12 --> 00:34:13 Link in the show notes.
00:34:14 --> 00:34:16 Piece of advice four, pick a broker, advisor, EBC.
00:34:16 --> 00:34:21 Pick someone who has the experience, number one, and also
00:34:21 --> 00:34:23 the financial alignment to help you.
00:34:23 --> 00:34:29 Listen to episode 512 with Doug Aldeen, who is an actual ERISA
00:34:29 --> 00:34:30 attorney for more on this one.
00:34:31 --> 00:34:34 Or listen to the episode with Justin Leader called The Mystery
00:34:34 --> 00:34:35 of the Weekly Claims Wire.
00:34:35 --> 00:34:37 Again, all these links are in the show notes.
00:34:38 --> 00:34:41 Also, all these links are in the weekly newsletter.
00:34:41 --> 00:34:43 Did I mention signing up for the weekly newsletter?
00:34:43 --> 00:34:44 You should do that.
00:34:44 --> 00:34:46 Go to relentlesshealthvalue.com.
00:34:48 --> 00:34:53 Frank Pennachio, is there anything I neglected to ask you that you wanna say
00:34:53 --> 00:34:59 in summary or a takeaway bit of advice or, or just something that you definitely
00:34:59 --> 00:35:03 want all listeners thinking about level funding to make sure they take on board?
00:35:03 --> 00:35:07 Stacey, I think employee benefits agents and brokers and consultants get up
00:35:07 --> 00:35:13 every day with the intention of doing great work and helping their clients.
00:35:13 --> 00:35:17 I think the intent is to, is to help in this, in these, these very
00:35:17 --> 00:35:20 challenging times, and it's overwhelming.
00:35:20 --> 00:35:21 It's coming so fast.
00:35:21 --> 00:35:25 The changes are coming so fast that it can be overwhelming for everybody.
00:35:26 --> 00:35:29 So I would just suggest, let's take a deep breath.
00:35:30 --> 00:35:33 The likelihood is the increased cost in healthcare are gonna
00:35:33 --> 00:35:35 sting, they're gonna hurt.
00:35:36 --> 00:35:39 They won't likely bankrupt most companies, but the risks
00:35:39 --> 00:35:42 you unknowingly assume could.
00:35:43 --> 00:35:47 So let's be moderate about our approach to this.
00:35:48 --> 00:35:51 There's no silver bullet out there.
00:35:51 --> 00:35:56 There's opportunities to reduce cost, and yes, we should be exploring those.
00:35:56 --> 00:36:00 Just how much risk do you want to assume in order for the
00:36:00 --> 00:36:02 potential to reduce your costs?
00:36:03 --> 00:36:07 Sage advice for probably way more than just level funding.
00:36:08 --> 00:36:08 Right.
00:36:08 --> 00:36:12 But it is very wise what you just said.
00:36:13 --> 00:36:17 Frank Pennachio, if someone is interested in learning more about
00:36:17 --> 00:36:21 what we have spoken about today, where can they find your book?
00:36:21 --> 00:36:23 Where can they find your classes?
00:36:23 --> 00:36:24 Yes, thesilentdanger.com,
00:36:27 --> 00:36:31 thesilentdanger.com, also the name of the book, and, uh, the website is there.
00:36:31 --> 00:36:34 And you can find me on LinkedIn, as well, with a little bit
00:36:34 --> 00:36:36 of commentary here and there.
00:36:36 --> 00:36:39 I'm thrilled when people reach out and say, Tell me more.
00:36:40 --> 00:36:43 Frank Pennachio, thank you so much for being on Relentless Health Value today.
00:36:43 --> 00:36:44 Thank you for having me, Stacey.
00:36:44 --> 00:36:44 It was a real pleasure.
00:36:44 --> 00:36:45 Appreciate it.
00:36:46 --> 00:36:49 Hi, I am Dr. Stan Schwartz from Zero.Health Relentless Health
00:36:49 --> 00:36:52 Value has been a real source of insight and inspiration for me.
00:36:52 --> 00:36:56 Every episode feels like a thoughtful, informed conversation that really gets to
00:36:56 --> 00:36:58 the heart of what matters in healthcare.
00:36:59 --> 00:37:02 If you're committed to moving the needle in this space like I am, I
00:37:02 --> 00:37:05 strongly recommend subscribing to Relentless Health Value Newsletter.
00:37:06 --> 00:37:09 For me, it's the best way to keep up with new episodes and stay connected.
00:37:10 --> 00:37:11 Thanks for listening.