We asked employee-benefits consultants this question: What do you expect the competitive landscape for employee benefits providers to look like 10 years from now?



Mark Newbold, principal and employee-benefits adviser, Moloney O'Neill Benefits: Assuming that federal health care reform continues to move forward as embodied in the Patient Protection and Affordable Care Act legislation, we can expect to see the same number of medical/prescription insurance options available—or more options available if the state health benefit exchanges don't implement overly restrictive rules governing how plans are to operate both within and outside the exchange.

It's important for the state health benefit exchanges to meet the requirements of the PPACA and not add additional restrictions and guidelines beyond what is provided for in the original federal legislation until the full financial implications of the PPACA are known.It's equally as important for plans to have the flexibility to offer whicheveroptions within and outside the exchange they wish to offer to employer groups with less than 50 employees. If the state health benefit exchanges expand the requirements beyond the original provisions of the PPACA, we will more than likely see a reduction in the number of options available to consumers. This would be an unwelcome outcome.

With employer groups of 50 or more employees, we can expect to see more of them investigating the merits of partial self-funding of their health plans as an alternative to fully-insured plans.This option has the potential of providing greater transparency in tracking health costs specific to an employer group, greater flexibility in benefit design, and greater potential for cost savings over time, assuming that the group's demographics and claims history are favorable to a partially self-funded group plan model. Plans that can serve this growing market will increase their market share. Those who aren't able to offer this alternative will see their market share decline over time.

We anticipate a reduction in the number of employee benefits brokers and consultants within the next 10 years, as the level of expertise required to serve employer groups will increase substantially.Those brokers and consultants who have the professional expertise and technological resources to evaluate plan performance and provide cutting edge advice on how their clients can effectively manage their health care spending will increase their market share. Those that are either too small or don't have the necessary resources to effectively serve their clients will see their market share decline, or they will disappear.

The role of employee benefits professionals will be much more consultative, and most services provided will be on fee basis rather than a commission basis. Those employee benefits brokers and consultants that can show their clients the value proposition of using a broker will grow in size and number ofaccounts at the expense of those who cannot demonstrate the value of their services.

All of this depends in large measure on how effectively the federal and state governments provide an environment where plans can be innovative and flexible in the types of benefit designs offered in a vibrant, competitive marketplace where the importance ofchoice is emphasized.

Anticipating these changes, our firm has allocated the capital necessary to build an infrastructure that will provide our clients with the tools and resources they will need to navigate the new insurance paradigm created by federal reform. With the challenges ahead, we look atthem as an opportunityto provide the servicesneeded toassistemployers in developingeffective strategiesto ensure that their employee benefits programs are successful in meeting their long-termfinancial goals while providing adequate coverage for their employees and their families.

As my father used to say, "When the going gets tough, the tough get going." The ability of employee benefits professionals to help clients navigate through the rough seas of reform to a safe harbor will determine their ability to survive and prosper in the years ahead.





Jeff Skeesick, vice president, Inova LLC, Associated Industries of the Inland Northwest: During the health care debate, Americans were assured health care reform would lower costs. Instead, costs have risen, and employers are increasingly confused by changing regulations and costly mandates. In this perplexing health care landscape, the present reality is that benefit costs have reached an average of nearly 25 percent of payroll.

If this course continues, I predict that over the next 10 years, many companies will stop offering health coverage to workers. In fact, a July 2010 survey of more than 1,200 mid- to large-sized employers, nearly one in 10 already planned to stop offering employee health coverage, though risking fines and taxes, less compensation for their employees, fewer choices, and increased costs.

Even if that trend doesn't continue, it's pretty clear employers are going to need a lot of sound advice in order to make smart decisions regarding their benefit programs. Producers and providers will be called on—more than ever—to provide solid benefits strategies. Unfortunately, the current medical loss ratio requirement, which prompts carriers to cut consultants' fees, might make access to their advice hard to come by.

My preference would be to see Congress scrap the entire health care law and find some common-sense answers to expand access, minimize mandates, encourage healthy competition, improve care, reduce costs, and offer more affordable choices. Do I see that happening within the next 10 years? Not as long as political parties care more about winning elections than solving the nation's health care troubles. Maybe it's time for a Health Care Swing Party.



Robert G. Gootee, CEO, ODS Health Plan Inc.: Niels Bohr, the father of atomic physics, had a way with words as well as with quantum mechanics. "Prediction is very difficult," he once said, "especially if it's about the future."

Such a caveat is particularly relevant intoday's turbulent worldof health care reform. But if I must reach for my crystal ball, let me just offer this. I think that in 10 years, our market in Washington will be characterized by increased choice for employees of plan designs from either a single carrier or multiple carriers through public and private insurance exchanges.

Also, there will be more strategic partnerships between health plans and local or regional health systems that enable them to offer products with more predictable costs, improved quality, and access.

Finally, almost unimaginable digital links will be created between a health plan member and the health plan, provider, and health system, all providing personalized information and decision-support tools.