Rob Carnaroli, Sutter Health Plus Vice President of Sales, was recently interviewed for an article published in the October 2021 issue of California Broker. The following are his responses.

What is the fall-out from the pandemic as far as large group health in California?
The increased uncertainty on future costs is a concern facing many health plans today. It is challenging for health plans to forecast future trends with 2020 data. We are all grappling with questions around whether costs will return to pre-pandemic levels, what legislative or regulatory changes may take place with testing and vaccinations, and if we will see further workforce changes and shifts in employer populations, to name just a few. We are carefully monitoring the situation to see what, if any, changes may be reversed or if they are here for the long-term.

What are the most effective ways to sell to large groups in California right now? Are there particular benefits or other aspects that brokers are honing in on?
Employers today want real value in the health care benefits they are purchasing. Astute brokers are keenly aware that carriers often unveil “new” features and benefits that on the surface appear effective, but they amount to little more than the latest marketing ploy.

Actual integrated health care that draws from resources inside a health system is far more effective than quilting together a myriad of vendors in an attempt to offer a better member experience, improve quality of care, and reduce healthcare costs. For example, in today’s environment, we are all well aware that there is a renewed demand for telehealth and virtual primary care and most carriers now offer some version of this service.

However, many of these carriers contract with remote physicians who are far removed from the local needs of their patients. Employers—and their employees—will get more value from a health plan that’s more connected with its provider network which gives it more control in the patient experience and the ability to ensure real accountability. The same discipline should be applied to other in-demand benefits such as real-time scheduling, online communication apps, walk-in-care, urgent care, symptom checkers, and pharmacy delivery services.

Is self-insurance or direct contracting impacting large groups now?
Brokers and large employers will always be interested in self-insurance options; however, it remains the seldom used solution in our geography for smaller employers and many in the mid-market space. The fiercely competitive Northern California landscape allows fully insured carriers to be very competitive on pricing, network options, and plan benefits in order to attract and retain business. Similarly, the direct contracting efforts by large employers with health systems have largely faded away, but there remains a small contingent of sophisticated national employers who still pursue these arrangements.

Is there anything on the horizon legislatively with large group health that concerns you?
At the state level, many proposed legislative bills have been delayed, so the immediate impact is yet to be understood. At the federal level, we continue to monitor the requirements and changing deadlines for the No Surprises Act and Transparency in Coverage final rule.

Most health plans are concerned with the significant infrastructure build needed to comply, while also competing with existing internal priorities. It is a significant logistical task to mobilize all the teams needed for implementation—Compliance, Legal, Information Technology, Operations, Communications, etc.

Rob Carnaroli
Vice President of Sales, Sutter Health Plus | LinkedIn