Why the Aetna/Humana deal signals the need for a fee-based model

Aetna’s pending purchase of Humana may happen, may not and, if it does, won’t close until late 2016. Meanwhile, UnitedHealthcare is eyeing Aetna. Anthem continues with its play for Cigna. Who knows? And unless you’re invested in one or more of their stocks, who really cares?

See also: Why the Aetna, Humana merger is a ‘lesson’ for brokers

What’s the impact on the benefits industry? The problem with employee benefits isn’t the cost of health insurance; the problem is the cost of health care. Health insurance — and, I will argue, health insurance companies — are basically a reactive component in the benefits ecosystem. Most innovations in the industry have come from outside the medical carriers. For example, the carriers “have” wellness programs but they are poorly deployed and largely ineffective. The outcomes-based wellness programs and predictive analytics that are bending the cost curve were pioneered by third-party vendors and benefit advisers. Health insurance companies find ways to game the system, to generate revenue and profit. No shame, but they’re not about the business of fixing the health care system.

So what real impact could Aetna absorbing Humana have on the health care system and costs? Not much that I can see. Any real impact would be at the margins. No one expects the medical carriers to improve health care; they’re expected to maximize the value of their stock.

Well, then, what’s the impact of the Aetna/Humana deal on brokers? The industry trend is clearly toward disintermediation (defined as the elimination of an intermediary in a transaction between two parties), cutting the broker out of the health insurance transaction. Aetna’s brilliant CEO, Mark Bertolini, began the trend in 2011 when he announced that Aetna and its broker partners were moving to a service fee model on large-group business, signaling the beginning of the end to commissions on large-group medical accounts.

See also: Is Aetna eliminating commissions on small group business?

Other carriers have begun to follow Aetna’s lead. Most recently, Aetna ended commissions on small group business in states that allow brokers to charge a fee. So it's fair to assume that if Aetna acquires Humana, it will move Humana down the fee-for-service path as well. The future just comes at us faster and faster….

What should brokers and benefit advisers take away from all the merger and acquisition activity among the medical carriers? The message is crystal clear. Now would be the time to move away from a dependency on medical commissions, take a fee in lieu of medical commissions where possible, introduce fee-for-service offerings, and find new insurance and non-insurance revenue.

The times they are a changing. And benefits firms had best be changing their business model in response…the sooner the better. Before it’s too late.

Griswold is an agency growth consultant and author of DO or DIE: Reinventing Your Benefits Agency for Post-Reform Success. His Agency Growth Mastermind Network helps agency leaders reform-proof their firm. Reach him at (615) 656-5974, nelson@InsuranceBottomLine.com, or through 21stCenturyAgency.com.