Episode Transcript

This has been generated by AI and optimized by a human. 

 

Amanda Gilbert (00:00):

Without a doubt, best practice is every three to five years. You should evaluate all of your benefit strategies, including your broker partner. Again, I know a lot of employers don’t do it because it feels like a heavy lift, but there are ways to kind of streamline that and just interview a small subset of brokers that come highly recommended.

 

Josh Schumacher (00:21):

The employee benefits industry has been stuck in a cycle that keeps costs rising and plan members underserved, but there’s a better way forward and it starts here. Welcome to Break the Cycle. Welcome back to Break the Cycle. I’m here today with Amanda Gilbert, the Vice President of Client Strategy and Engagement at Apex Benefits. And today we’re going from theory to practice. Amanda’s going to walk us through real client relationships, the problems they faced, how they solve them, and the impact of deploying creative strategic solutions. Amanda, thanks for being here.

 

Amanda Gilbert (00:53):

Thank you, Josh.

 

Josh Schumacher (00:55):

So let’s start just talking about patterns you see when working with different employers. What do you think you see over and over again that kind of indicates a client is stuck maybe in the same old pattern of waiting for their renewal to come in?

 

Amanda Gilbert (01:10):

So when I though through this, I had a couple ideas come to mind, but the number one thing that I thought of was complacency. So you hear a lot of times over and over, we have a relationship with our broker. We’ve worked with them for 10 plus years. So I would say complacency is the number one thing.

 

Josh Schumacher (01:28):

And why do you think people become complacent with something as important as employee benefits?

 

Amanda Gilbert (01:34):

I think a lot of it has to do with that’s just what they’re comfortable with. It’s a complex topic and they may be comfortable with their current broker and maybe they just don’t know what else is out there or there’s a perception that it’s a big heavy lift to make a change.

 

Josh Schumacher (01:51):

And what do you feel like that gap actually costs employers? So if they’re not willing to make a change, they’re sitting there every year, their renewal’s just coming in over and over again, what’s the real cost to an employer approaching that strategy that way?

 

Amanda Gilbert (02:04):

I think there’s several costs. I think there’s real dollars at risk if you’re not exploring other funding mechanisms or other creative solutions. So there’s real dollars at risk there. There’s also a risk of your benefits not being competitive and you’re not able to attract and retain top talent within your industry. I’d be remiss if I didn’t mention that there’s also a fiduciary responsibility there. Employers are managing their employees’ money and they do have a responsibility to make sure that they’re being good stewards of their employees’ money. So from a compliance perspective, there’s a risk there. And then also just organizational alignment, making sure that your benefits are aligning with your strategic goals as an organization.

 

Josh Schumacher (02:49):

And do you feel like most organizations, when you step in and you start working with them, do you feel like there is organizational alignment or is that something that you find is more rare when walking into these situations?

 

Amanda Gilbert (02:58):

I would say it’s probably more rare. So our process at Apex is to bring HR and C-suite together so that they are aligned from not only a people perspective, but also from high level organizational goals. If those two are out of alignment, then you’re going to have some challenges with your employee benefits.

 

Josh Schumacher (03:19):

I think that’s a great way to set the stage for this conversation, talking about organizational alignment. Let’s dive in now to how that kind of comes to life in the real world. So what’s the first example that comes to mind when you think of a client that needed help with their strategy, needed to get aligned, and what you guys did about it?

 

Amanda Gilbert (03:36):

Yeah, so we have a private university client who was facing a challenging fully insured renewal earlier in 2026. And I think they were open to exploring different ideas. They really weren’t sure which direction they wanted to go. They were interested in maybe moving to self-funded or looking at some custom solutions. So we had a strategy meeting with the president of the college and then the HR leadership and then also CFO and talked about their risk appetite, what they were willing to do, where most of their people go from a health system perspective. And ultimately we determined a more custom solution than just a traditional national Anthem United Healthcare approach. So we ended up moving them to a unique solution with a local provider, still fully insured funding arrangement, but we did a custom network for them. One of the things we found out during our strategy session was they have a pretty close relationship with the local health system in their area, and that’s where most of their people go for care.

 

(04:46):

So with this custom solution, we were able to not only save them money, but create a solution that would help them transition over multi-year into potentially a different funding mechanism to control their costs better, and then also partner with their local health system, which their people were already using.

 

Josh Schumacher (05:05):

Yeah. And that to me sounds like exactly the kind of intel you only get from a conversation that brings all of the leadership to the table, the ones that understand what their employees are utilizing, those who understand the CFO, who understands the big financial picture. So that strategy meeting, that sounds like the kind of intel that gets discovered in a meeting like that, that brings everyone that has a stake in the benefits program to the table from a financial perspective, the HR team who really understands the employees. Can you walk me through a little bit how that conversation goes, what that was like, and how you uncover some of those gems that really help drive strategy?

 

Amanda Gilbert (05:40):

Yeah. So we arm our team with a list of questions to ask clients. You’re not always going to ask every question to every client. It’s a customized list, but it’s designed really to get to those C-suite conversations and to those organizational alignment and goals discussions. So in this particular meeting, we started asking, well, long-term, are you open to evaluating self-funding or maybe baby stepping into with a level funded program? And ultimately we decided to stay fully insured, but do something a little bit more custom that could help, we could build on over time through our long-term strategy. So having those conversations about the partnership with the local health system and their risk appetite, how they’re looking to grow and keep their benefits competitive, we uncovered some useful information that helped us put together just a custom strategy.

 

Josh Schumacher (06:37):

Yeah. So speaking of custom strategies, are there any other unique stories that come to mind when those strategy meetings have created a unique custom solution for a client that really worked?

 

Amanda Gilbert (06:49):

Yes. One that comes to mind just recently, I was part of a strategy meeting, was a healthcare client. And through that session, we learned that they won a big grant through the state and they’re going to be adding about a hundred employees. So obviously that impacts benefits, it impacts budget, and impacts everything about their self-funded plan. So through those strategic conversations, having the C-suite in the room oftentimes leads to discovery that impacts benefits. So we’ve really been intentional the past year or so empowering our team to have those conversations so that it can help power our long-term strategy.

 

Josh Schumacher (07:32):

And it really is kind of all about that long-term strategy because benefits we know is not a single year game. Talk to me a little bit about how you manage that strategy. Maybe another example that comes to mind. There’s obviously so many vendors in the healthcare space and there’s so many unique niches that you need to focus on. How do you bring a strategy to life once you’ve identified, “Hey, this is what we want to do?”

 

Amanda Gilbert (07:57):

So there’s multiple pieces. I mean, you have to understand the market, the different carriers, TPAs and vendor partners, but you also have to understand networks and demographics within your client. Where are they accessing care? What type of flexibility do they need? It’s always going to drive recommendations from carrier partners, TPAs, and networks. And so in the financial piece is always going to be the decision maker. So you have to understand how all the pieces fit together and help control costs while also limiting disruption for members.

 

Josh Schumacher (08:35):

Yeah. Do any other really unique stories come to mind when you think of your hands-on experience with clients and how you’ve solved some of the challenges that they’re facing?

 

Amanda Gilbert (08:44):

I think a lot of my experience has been working with healthcare employers over my career. So I feel like I have a unique skillset when it comes to direct contracting and working with local health systems and getting creative on those direct contract deals. But you also have to understand in the background who the carriers are, who the vendor partners are, and what type of flexibility that you can do because you can have the best idea in the world, but somebody has to administer it. So it’s understanding all of the pieces in order to make those recommendations.

 

Josh Schumacher (09:20):

So three very different clients, three very unique examples of people trying different things. What did they have in common? What’s the kind of through line on those three different clients that you worked with?

 

Amanda Gilbert (09:31):

So the number one thing would be they were all looking for a solution to control cost. And then the second piece would be they were all willing to be engaged, to listen and to try something new and creative, a different approach than what they have been trying in the past.

 

Josh Schumacher (09:48):

Can you tell me a little bit more about that?

 

Amanda Gilbert (09:50):

Yeah. So two of the three examples that I gave were with more traditional approaches with their medical plans, large national networks, little disruption to their employees. It’s what they’re used to. Big name insurance carriers where with some of the creative solutions that we brought to the table would be a little bit of a change for their employees. So moving away from a large national network to more of a customized network that still provides the coverage that their employees need and want, but it’s more customized based on their utilization and then partnering with other employers in their communities that are health systems that their employees can access.

 

Josh Schumacher (10:33):

And you said two of them were kind of in a more traditional model. Can you talk to me a little bit about what you feel like separates Apex? Is it something that separates Apex to bring those creative solutions to the table? Because it seems like something that previous broker could have done or maybe it wasn’t the right time to do it and now it is. Talk to me a little bit about what most clients that you’ve worked with have been experiencing and then maybe what the switch is like.

 

Amanda Gilbert (10:59):

Yeah. So the traditional model is the easy button, right? And that’s the large insurance carriers that we all know of, that we’ve all heard of. The more challenging solution is to get creative and work with a partner that understands different network options, different TPA and carrier vendor options that can bring more flexibility in how you design your benefits. The private college example that I gave, it’s not just, we didn’t just change the carrier in the network, but we also changed the plan design. So incentivizing employees to steer care towards the best option or the best pricing option with the best outcomes while also limiting their disruption.

 

Josh Schumacher (11:43):

What should an employer do to kind of move beyond just the examples of these people getting creative? What should an employer do if they feel like they’re not getting that level of collaborative problem solving when it comes to their benefits strategy?

 

Amanda Gilbert (11:57):

I think they should pause and do a little research. I would never recommend that anyone just automatically do a broker review or a formal RFP. It’s a heavy lift for any employer, but talk to some employers in your community, talk to some of your peers or colleagues. Do they have good experience working with an advisor or a broker that’s creative and continuously bringing value to the table? And then select a handful and then interview. Interview your brokers, ask them specific questions and get some case studies on how they’ve made a difference and created better benefit programs for their employees.

 

Josh Schumacher (12:36):

So you mentioned earlier kind of the fiduciary responsibility that organizations have to take care of their employees’ medical costs. You also said you know plenty of people that have been with the same broker, same strategy for 10 plus years. Obviously with six to 8% trend in the industry, 10 years is a long time to wait to let those costs keep arising. How often do you think employers should really be thinking about their strategy, thinking about, am I doing the right thing for my plan and my employees?

 

Amanda Gilbert (13:05):

Without a doubt, best practice is every three to five years. You should evaluate all of your benefit strategies, including your broker partner. Again, I know a lot of employers don’t do it because it feels like a heavy lift, but there are ways to kind of streamline that and just interview a small subset of brokers that come highly recommended.

 

Josh Schumacher (13:27):

So having worked with clients day in and day out for years in your career now, what do you think separates a broker from maybe a trusted advisor and someone that will partner with you in those creative ways?

 

Amanda Gilbert (13:41):

They have to continuously provide value. If they’re not bringing new ideas to the table, new funding mechanisms to consider, analysis around that, numbers behind that, and staying on top of what’s trending in the market, new solutions, it changes so fast. So yeah, I think it’s continuously providing and bringing value on an annual basis. If you’re feeling like you’re not getting that every year, then it might be time to take a look.

 

Josh Schumacher (14:12):

And does it go beyond an annual basis? I know something we talk a lot about in the space that many of our previous guests have mentioned is just the fact that often brokers show up at renewal. Here’s your number, here’s what you’re going to get. Is that an appropriate level of partnership in this day and age or is it something that’s more year round?

 

Amanda Gilbert (14:32):

It’s definitely year round. If you’re not at least meeting with your broker quarterly, you’re probably missing something or leaving a strategy out or a new solution out, just staying on top of your data and managing your financials.

 

Josh Schumacher (14:47):

So we’ve talked about getting in a room with a trusted advisor and kind of getting creative and trying to come up with new solutions, new strategies. What’s the impact been that you’ve seen when clients take that approach?

 

Amanda Gilbert (14:59):

So I think it opens their mind to other possibilities. They’ve taken a step that seemed a little scary initially to do something creative. And now we’re seeing the private university client, for example, we’re seeing them wanting to look at other funding mechanisms. They’ve taken that first steps. They’ve seen what’s possible, that it’s not going to be super disruptive to their employees. Because they worked with the right partner to put the proper guardrails in place and understand and be intentional about employee disruption and education. Now they’re more open to exploring other creative ideas and opportunities.

 

Josh Schumacher (15:36):

It’s a whole new world for them.

 

Amanda Gilbert (15:37):

It is.

 

Josh Schumacher (15:38):

Yeah. At the end of the day, when you see a client deploy one of these creative solutions, how does it make you feel?

 

Amanda Gilbert (15:44):

I mean, I think it always makes our team feel proud that a client trusts us in order to take our recommendations and when it actually works out, both financially and for their employees. A lot of times these decisions make a huge difference in employees’ lives and what’s coming out of their paychecks and the care that they’re receiving. So it’s why we do the work we do.

 

Josh Schumacher (16:05):

Well, Amanda, thank you for the conversation today. I think there’s lots of takeaways. The big one from my end is work with a creative partner that you can trust and be willing to come to the table and see what’s possible. Thanks for listening in. Remember, you don’t have to repeat the same outcome. You are built for better, and we’re here to help you see how you can break the cycle. Thanks for joining us for this episode. For more on how to break free from the cycle of rising costs and painful renewals, subscribe wherever you get your podcasts.