In a broken healthcare system, an adviser offers custom medical plans

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After more than a decade of working for other brokerages steeped in traditional advising, Megan Cook took a risk and started her own company with the goal of doing her part to fix the “broken” healthcare system.

As one of the first 30 brokers to become a certified benefits adviser through nonprofit institution Health Rosetta, Cook is committed to exploring new ways to end the annual cycle of delivering the same annual premium increases to clients that don’t provide any cost-saving solutions.

“My goal was not to continue down the path of doing spreadsheets,” says Cook, who launched her own firm, Adept Benefits, more than three years ago.

Since founding the Bellevue, Wash., boutique brokerage, she’s been focused on moving clients into completely customized medical plans that are providing better benefits at up to a third of the cost, Cook says.

“There are so many employers out there who want to be helped,” she says.

One of the ways she is helping is by introducing them to direct contracting with hospitals and encouraging them to focus on primary care. While specialists often receive sky-high reimbursements as much as 700% above Medicare, primary care physicians are typically reimbursed at lower rates, Cook says. That gives them “a huge incentive” to send patients off to a specialist and move on to the next patient as quickly as possible.

By changing up the model with direct primary care, Cook says, employees get the service for free and are meeting with their physician for as long as 45 minutes. “You have someone who is truly assessing the person holistically, not just element by element and sending them to specialist,” she says. The result is fewer labs, x-rays and prescriptions.

Making the switch can reduce an employer’s costs in the first year by up to 20%, Cook says. This includes helping the “small pocket of employees” that make up the bulk of employers’ annual healthcare spend to find the high-quality, low-cost facilities to utilize and then incentivizing them to do so through free or heavily subsidized care at those locations.

See also: How a broker eases employers’ healthcare burden

Jill Luchmun of Vaughan Co. in Montesano, Wash., first worked with Cook about eight years ago through Cook’s old brokerage and then “chased her down” after Cook left to start her own firm. “She knows the business better than anybody I’ve ever seen,” says Luchmun. “She’s honest, straightforward, and she tries to get the best deal no matter what. She’s very transparent about everything.”

While the goal is to find clients who are 100% onboard with these cost-saving healthcare initiatives, Cook admits she is still growing her business, so there is a balance between working with forward-thinking employers and those who are comfortable with the status quo.

“A lot of times it is difficult for clients to get their head around this, because it's the first time they've ever heard of it,” Cook says. “Most of them are slowly getting on board. Some of them have completely jumped in and made huge strides in saving tons of money, while others are going at a little bit slower pace.”

Luchmun has about 60 employees on Vaughan Co.’s company plan, with a couple hundred members total. She switched to a self-funded plan this year with Cook after experiencing 25% rate increases the last three years when not working with Cook (due to a non-compete). Now that she’s with Adept Benefits, the plan is projected to reach as much as 50% savings this year.

“I feel like we’re a lot more in control now. It’s a great program and very exciting,” says Luchmun. “So far, it’s going very, very well.”

As business develops, Cook plans to move toward a percentage savings compensation structure. Implementing direct primary care, self-funding and more takes a lot of time and education, she says. Recently, she spent four days straight making presentations on the process to prospective clients.

Sara Tarp is a senior account manager with Adept Benefits. Like Cook, she’s driven by helping companies and their employees navigate the complexity of healthcare and enjoys presenting them with new ways to tackle expenses.

“Adept Benefits is on the cutting edge of the employee benefits industry,” Tarp says. “The consulting we are doing for clients is unlike the traditional consulting that clients are accustomed to. After giving presentations, clients often say to us, ‘Finally, some good news!’”

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