Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
David Saltzman (00:00):
Is it possible
for employers to control their
healthcare budget and giveemployees more choice at the
same time?
We'll find out on this episodeof Shift Shapers.
Announcer (00:12):
Change either
energizes or paralyzes.
The choice is yours.
This is the Shift ShapersPodcast, bringing the employee
benefits industry interviewswith individuals and companies
who are shaping the industry'sshift.
And now, here's your host,David Saltzman.
David Saltzman (00:32):
And to help us
answer that question, we have
invited my old friend ChadSchneider, who's head of broker
channel at Thatch, to join us.
How are you doing?
Chad Schneider (00:41):
I'm doing great.
Always good to see you, David.
David Saltzman (00:43):
Uh, it's a
pleasure, and thanks for making
time to chat with us a littlebit.
Let's level sec.
For for folks who don't knowwhat is an ICRA.
Chad Schneider (00:52):
ICRA.
It's a uh, you know, leave itto the government to have a
terrible name, but uh an ICRA isthe individual contribution
health reimbursementarrangement.
So it was a uh basically a lawthat was initially passed back
in 2020, end of 2019, officiallyenacted into 2020, uh in the
Trump administration v V1.
And uh basically allowed theemployers to be able to say,
(01:15):
great, let's go ahead and giveyou some more optionality.
If you want to be able to takeyour current group health plan
and be able to basically dropgroup health coverage and be
able to now give your employeesa stipend or allowance, and they
can basically use that moneyfor uh obviously it has to be
used for like an insurance plan,medical insurance plan first,
but you know, cap costs, givethe ability to be able to have
(01:37):
choice, you know, and then nowevery employee can get their own
health insurance plan.
And that was basically the thewhole concept of that.
So um 2020 was the very firstyear.
I would say realistically, itwas slow going the first couple
of years.
You know, there was a handfulof like early adopting
administrators and a couple ofthe brokers out there, but the
big first year candidly wasprobably the last year, 2024, I
(02:00):
think was like the big boom, ifyou will.
Um, this year is gonna beabsolutely explosive for ICRA
and uh it's here to stay, that'sfor sure.
And depending on what goes onin the beltway, uh, there's uh
some legislation that's gonnacodify it and actually change it
from ICRA to choice, which is amuch better name for uh all the
uh all the marketing out there.
David Saltzman (02:21):
To what do you
attribute the big boom last
year?
What changed?
Chad Schneider (02:25):
Yeah, well, you
know, for all of us that have
been in the business for formore than uh you know a couple
minutes here, employers are justtired of it.
Uh, they're just tired of therat race every single year,
knowing that their biggestexpenditure next to payroll is
going to go up, you know, 10,15, 20, 30 percent every single
year.
And uh I think they're justtired of it.
So, employers, of course, theycare about their employees, they
(02:47):
want to be able to offer greatbenefits, they want to be able
to offer a great package, butthey just can't, they got to get
off the hamster wheel of, youknow, what else can we do?
And uh, why are we still doingit the exact same way we have
been doing it?
So I think that's reallycausing it and and triggering
it.
Take the take that up againstthe fact that the carriers are
much more uh in line because Ithink that was the problem in
(03:08):
2020 is if you go to certainmarkets, there'd be like one
carrier that might actually likebe in play, where now uh most
of the carriers are are actuallysaying let's actually you know
expand coverage, have morepolicies that are going to be um
you know better for theemployees on the individual
market.
And and very quietly over thelast, you know, let's say you
know, five, six years, theindividual market has actually
(03:29):
grown so large that uh the riskpool has been like, oh my God,
like what happened to this?
So I think a lot of the groupbrokers are so focused on group
they actually have forgotten ordidn't even realize how big the
individual market you know hasexpanded.
So that's all those factorskind of came together in a
perfect storm.
David Saltzman (03:46):
Well, you know,
a lot of folks walked away from
the individual market, or itwasn't top of mind once ACA
passed.
And you know, they they almostsome some brokers, the folks
that you and I both know, justkind of wrote that off.
Chad Schneider (03:56):
Right, right.
And it's like you've got theindividual brokers, the the uh
the IFP that are so focused onit, they really don't care about
group.
And then you've got the groupbrokers that are so focused on
group that they you know, we geton some of the calls and they
are like, wait, how does thiswork?
Like, well, what's what's thisindividual stuff?
It is pretty wild in terms ofthe disparity.
So, you know, there's a lot ofeducation out there, but with
(04:18):
education, with marketing, withyou know, a ton of TPAs like
myself out there now, uh, youcan't turn around without seeing
you know five million ads forsomething ICRA and ICRA this and
ICR that and ICR guides.
I mean, there it hits you everysingle day from every single
publication.
So now if you aren't looking atit, it's uh it's kind of like
voluntary benefits 15 years ago,where like if you weren't
(04:39):
talking about VB, you were gonnalose the group to somebody it
was.
And I remember being on thatbecause I was on the early, you
know, uh early uh stage andtrail for for that too.
So this feels very similar, youknow, 15 years later.
David Saltzman (04:52):
So, you know,
we've talked a little bit about
some of the advantages and we'lldelve into that in a little
more detail.
But especially as an advisor,what are some of the biggest
challenges that an advisor andan employer faces, you know,
when when they're trying toimplement or recommend and
implement an ICRA?
Um, you know, flexibility,administrative complexity,
compliance, employeesatisfaction, all those things
(05:14):
that advisors have to deal with.
Chad Schneider (05:16):
Yeah, totally.
Okay, fair question.
The biggest challenge, youknow, that we see, and I think
is you know industry-wide is howam I gonna do this new thing
called change management?
Even if the numbers work out,even if I like the cost
modeling, and now I have to goto my employees who've been
doing uh you know benefits acertain way for so many years,
and now I have to explain tothem that they're gonna have to
(05:36):
buy their own plan.
And um, that right there isprobably one of the biggest
challenges for an employer to beable to wrap their brain
around.
Um, you know, as my my CEOlikes to say, group benefits
today is you know, imagine goingand telling your employees to
go to a foot locker and say,every one of you, go pick your
size seven shoe.
And that's essentially whatyou're doing, where it's like,
yeah, I need this, I need this,I want this.
(05:57):
You know, healthcare is local.
So the ability to articulate,explain, educate, change,
manage, make sure the employeesunderstand that, like, yes, you
are picking a plan yourself.
Uh, this is actually how thisis gonna work.
But even actually, let's take astep back further.
Part of what we do is a bigdifferentiator, but also has
been the main challenge for thefirst couple of years of ICRA.
(06:18):
If you really pop the hood, thechallenge is more fintech.
And and when you think aboutthat, today it does take a
hundred person group.
I've got one bill with onecarrier, you know, and all my a
hundred employees are under thatbill.
Well, with Icra, I could have ahundred bills with seven
carriers in five states.
And now all of a sudden it'slike, oh my God, what do I
(06:39):
actually do?
So the money movement, thefintech, the the the behind the
scenes is actually where it'sbeen the most chaotic out there.
And so uh that is you know whatwe specifically are solving for
first is like a more, I wouldsay, infrastructure first
company.
But I think you know, if youtalk to most employers out there
that have not adopted it yet,they're very nervous about how
does that actually work?
Is this gonna be, is there away to do a some group like
(07:02):
experience, but also explain tothe employees?
And you know, I I say this, Iknow this is a controversial
opinion.
I think most brokers will agreewith me, and most employers
will probably disagree or agree.
I think it's maybe one of thosein the middle, but most
employers are like, are myemployees gonna actually be able
to understand and grasp thatyou know they now might have 50
to 100 choices and individualplans where they've always had
(07:25):
one.
Um employees are a lot smarterthan I think employers probably
take them for.
I know that every year at openenrollment is always chaos, and
there's a lot of that uh youknow, angst and and you know,
some of those issues, butemployees are a lot smarter.
Give them the ability, educatethem, give them the tools and
resources, they will figure itout.
And I actually think they'regonna be more empowered and be
like, oh my God, this isactually kind of cool.
(07:46):
I get to pick, you know,amongst 80 plans instead of
being told this is the one planthat doesn't fit my needs.
So um, all those factors Ithink are the biggest, you know,
angst around there.
But the money movement, thebilling, and making sure, you
know, when the employee goes tothe doctor's office, do they
have coverage?
Right.
I mean, that's actually likepart of the the the the chaos
(08:06):
out there is like some of theTPAs.
It's like once you enroll, whatwhat happens?
Do I get something in the mail?
Do I get this card?
Where like in the group side,it's like here, here, here's all
the emails, employer can'tcontrol it, broker has much more
control.
So um, long answer to a shortquestion, but those are, I would
say, the the the heartburn andthe trepidation that is out
there that basically brokers,TPAs, that's what we're all
(08:28):
trying to solve for.
David Saltzman (08:30):
Is there
decision support tools?
Are there decision supporttools built into the interfaces
that you guys provide?
So, I mean, especially thefirst year, if I'm an employee
and I'm faced with here's awhole menu of stuff, choose what
you want, it can beintimidating and confusing
because you know, you and I bothlook at the Kaiser Foundation
healthcare literacy responsereports every couple of years,
(08:50):
and it hasn't changed.
Folks just don't understandthis, or they convince
themselves that they don'tunderstand it.
So, what tools are on on theplatform to help folks make
those decisions?
Chad Schneider (09:01):
Yeah, I mean, I
would say that you know, that is
part of obviously putting thebetting that you have to do, you
know, with our platformspecifically over here at
Thatch, we have you knowstate-of-the-art decision
support.
It's actually the the UI isvery clean.
We want to make it as easy asbuying a ticket on Expedia,
right?
Like it should be that simple.
And I think the proof is in thepudding.
(09:21):
If you think about you knowsome of the competitive
differentiators out there, thefact that our entire book of
business over, you know, I mean,like you know, significant
amount of employers in a veryshort amount of time, 80%,
almost 85% of our enrollment isactually completely done without
speaking to a human.
And so I think that actuallyshows how good the tech is.
And this is not just like25-year-old tech companies.
(09:43):
This is, you know,construction, landscaping,
manufacturing, you know, everyshape and size in between.
So, but yeah, the decisionsupport should give you the
ability to be able to say,great, um, what's important to
you?
How much money over what youremployer is giving you are you
willing to spend?
You know, how budget consciousare you?
Cool.
What about you know choosing adoctor?
You know, I need to make sureDr.
(10:04):
David is in my network becauseif I don't see Dr.
David, I I don't care about anyof the plans on there.
How do I do that?
Um, how do I see some of theSBCs side by side?
How can I make sure to be ableto uh dig into just any of these
you know factors, right?
So that is that that should bethere.
That's what we do.
That's you know, with you know,giving you all the different
tools and resources to make thatreally good decision.
(10:25):
And most people are saying,okay, great, like I understand,
I get it.
This is uh this this isreasonable and smart.
And then you have the the edgecase or the really complex
situation where it's like, hey,I've got a lot of different
procedures, I've got a lot of uhprescriptions, I really need to
talk to somebody.
And then you should have theability to speak to somebody.
You know, we do that.
We have a whole team of youknow licensed uh agents
(10:47):
internally that are specificallysubject matter experts for the
state.
So if you have my employee inin Pennsylvania, you're gonna
speak to someone that knows thePennsylvania plans and markets
to be able to really help themmake that choice.
And that's that's even betterbecause now I can actually walk
through and show them like,okay, this is the most
comprehensive, this is thelowest cost, here's actually
what's going on, this is what'sgonna happen with these specific
(11:09):
areas.
And the other piece, which iswild, is uh you get more
carriers, right?
You know, the the brand name,of course, of like the blues and
the UHC are clearly out therebecause that's what the
employees have had.
But now all of a sudden, andI'll use perfect example, you
know, and I start digging in, Iwas like, Ambetter, who the heck
is that?
Or uh, you know, Oscar, who theheck is that?
And so now you actually havesome of these new carriers that
(11:32):
are disrupting, you know, thetraditional forces that have
some pretty kick-ass benefits.
So all of a sudden I now get uhaccess to some of them as well,
which is very, very cool.
David Saltzman (11:42):
And now a word
from our sponsor.
If you're like most advisors,you've used platforms that
promised to help, but only addedwork.
Outdated legacy systems,weeks-long setups, endless data
formatting headaches.
Venopower changes all that.
Built by Benefits Pros forBenefits Pros, it was designed
(12:03):
for AI from day one soeverything works faster and
smarter.
They integrate vendors in days,not weeks, and take any data
format, Excel, PDF, whatever,and make it usable instantly.
Venapower's Truvo app givesemployees real-time AI-powered
help by chat, email, or voice,and pre-authorization alerts
(12:25):
prevent costly surprises.
You get performancemeasurements and one-click
reporting, so you spend lesstime on admin and more time
growing your book.
Move from frustration tofreedom, from vendor to trusted
advisor with BenePower.
For more information or toschedule a demo of Benipower
Advantage, go to BenePower.com.
(12:46):
And now, back to ourconversation.
So, what are some commonmisconceptions or pitfalls that
you see brokers or employershaving about ICRAS?
Chad Schneider (12:57):
Yeah, there's
quite a few these days, just
because um I'll qualify this bysaying I have been doing just
hundreds and hundreds andhundreds of you know demos and
presentations and working withsome of the top brokers in the
country.
And even the most powerful bignames, you know, I always start
the meeting saying, How many ofyou in this room have sold in
(13:17):
ICRA?
And uh, you know, maybe one,maybe two, you know, and and
then I always say, on a scale ofone to ten, what is your
knowledge of ICRA in terms oflike, you know, really getting
into it?
Ten meaning you're an expert,and one meaning you barely even
know what the acronym is.
And on average, you know, threeis about the answer.
And that's actually very uh, Ilove the vulnerability that some
(13:38):
of the brokers have.
And maybe, maybe it's becauseI've known them for so long that
they're probably more honestwith me.
But like uh the fact that theyare even saying three is is
pretty wild.
So, with that being said, whatare the what are the
misconceptions?
God, where where do I start,David?
It's uh it's is there evenindividual plans that are worth
it?
Or, you know, oh, individualplans are way more expensive
than than the group insurance,or um, you know, the you can't
(14:03):
offer uh a employees are gonnahate the experience, or uh, you
know, what's gonna happen from aretention standpoint?
Because obviously benefits areyou know, the the the big thing
we've all been saying for yearsis attraction and retention.
Are you actually gonna get allthese different areas?
So those are some of the thekey ones.
And you know, we have to dispela lot of those myths,
(14:24):
obviously.
And we have to be able to showthe data and show the surveys
and show the traction and andall that kind of stuff.
But just in answering thosequestions and even just starting
knowing that, okay, these arethe ones that are gonna come up.
Let's have this get themaddressed right from the get-go.
And also the big one is youknow, servicing.
How is that actually gonnawork?
Um, what do I as the broker do?
You know, if if you know theold world, this is what I did,
(14:46):
but what do I do now?
And this is new world.
So um, this is a big change.
And I think it's probably asbig of a change, maybe not as
dramatic, but like if you goback to 2010 when when you know
ACA passed, like there was a lotof that same stuff, like what
you did in 2005 versus what youdo today, man, wildly different,
right?
So I think this is another oneof those time periods where uh
(15:07):
it gives a broker the ability toreinvent themselves and be able
to actually expand services, domore, have subject matter
experts.
Some firms have a whole ICRA uhcenter of excellence with some
awesome intelligence there.
And then some are like, yeah,we're just kind of getting
started.
We know this the thing is thisthing is a thing, we might as
well start diving in.
So it is pretty wild out there.
David Saltzman (15:28):
So let's flip
the script to the next chapter.
How should employers thinkabout plan design, contribution
strategies, budgetpredictability in the context of
an ICRA?
Chad Schneider (15:39):
Yeah, totally.
So I think it depends on ifyou, you know, always start with
what are you trying to achieveas the employer?
And I mean, let's face it, mostwill probably not admit, but
it's like some employers come inand say, I literally want to do
the minimum so I can becompliant and I just don't get
dinged.
Uh, some are saying, no, wereally want to like flex and we
(16:00):
want to make sure our employeeshave unbelievably cool benefits,
and we want to make sure thatwe're offering every possible
nook and cranium that we can.
So starting with the like, whatis your actual goal?
What are you trying to achieve?
What's going on?
That's where we can be reallycreative.
And there's a lot of strategiclevers.
And I think part of what theother thing is, you know,
there's 11 classes that you cancarve out for an ICRA.
(16:21):
So you can do it by like stateor part-time, full-time, you
know, things of that nature.
So the ability to say, okay,what if I were to actually do a
carve out?
How would this actually changemy group renewal?
What's the strategy for thoseemployees that are on the ICRA?
Gives you a lot moreflexibility to be able to say,
we can be creative and we can dosome of these kind of things.
But uh, you start with, youknow, what's the budget you have
(16:42):
in mind?
Uh, what are you spendingtoday?
Are you looking to be able tohave it plans that are
equivalent to what you have?
Or are you actually looking tobe able to say, no, I want to
beef it up because I want myemployees to be able to spend X
amount of dollars?
So you always have to startwith a lot of discovery around
like what that looks like.
But what we actually do, whichis pretty cool, is the ability
to have this dynamiccontribution strategy because
(17:04):
sometimes there's just a uh flatdollar amount saying, David, we
all get you know $1,000 amonth, pick and choose.
Well, let's face it.
And uh the the example of thethe 26-year-old in California is
gonna have very differentpremiums than the 55-year-old in
Florida.
Like, you know, that that's theobviously giant disparity.
So $1,000 doesn't go as far forthose two.
So we have this dynamiccontribution strategy, which
(17:27):
allows to be able to say, we'regonna pick a certain benchmark
level plan, and then everyonewill be able to purchase that
level of coverage in their localmarket.
So your premium will be X, minewill be Y, but compliantly it
actually grows up to the samestrategy.
That is something thatemployers love to be able to see
because now you actually haveparity.
Now you have that new equitything where um, let's face it,
(17:48):
you have to, and you know,you're like as an HR person,
you're not gonna go in and belike, you know, cool,
everybody's getting worsebenefits.
Uh, and you know, you have tobe able to have a good story at
open enrollment and why you madethis change.
So that type of stuff is isreally cool.
But then it becomes what arethe additional perks?
Like, how do I wrap inancillary and voluntary?
Uh, are there additional thingsthat we can offer to the
(18:10):
employees that you know maybe Ididn't have access to in the
past?
You know, some of the some ofthe perks, right?
Uh, the mental health, thephysical health, you know, GLP
ones, all that kind of stuff.
So all those factors come intoplay.
And then we can say, great, youknow, now that we understand
where you're going, what yourbudget is, what your your your
goals as an organization are,now we can put a great package
and proposal together.
David Saltzman (18:31):
So we spend an
awful lot of time on the program
talking about data andanalytics.
And the question is, you know,what role do those things play
in the member experience anddriving the success or maybe
even the failure of an ICRAprogram?
Chad Schneider (18:45):
Yeah, totally.
Well, because you know, at theend of the day, you're still now
dealing with individual planswhere, you know, obviously in
the self-funding world, you canget claims experience, you can
get some of that you know dataon the individual plans.
You know, you really can't,obviously.
And then then there's a wholedifferent level of uh ball of
wax there.
So from the standpoint of likeengagement metrics, you know,
(19:07):
satisfaction metrics, enrollmentmetrics, like you know, again,
you know, doing some some surveydata, things of that nature,
obviously that's where it'sgoing to be able to come into
play.
Um, the carriers today arevery, very behind on the
individual side where likethey're getting better every
single day.
And you know, as mentioned,like I would say the Oscars and
the M betters are are forcingall the other carriers to be
(19:28):
able to kind of beef up whatthey're looking at.
But you know, they will evensay, like, we've been building
out so much on the group sidesince ACA passed, you know, APIs
and EDIs and all these otherthings, where on the individual
side, it's still pretty nascent,uh, in terms of how I mean,
it's like, you know, do you needto faction a uh an application
still in 2025?
And some carriers might sayyes.
(19:49):
Uh, some are saying no.
Here's a full API that we canbe able to work with.
So I would say the the moreinnovative things are can you
track an application fromsubmission to issue?
That is something that's youknow fairly new.
Uh, that like I I know I knowwe are the first one to be able
to have like a true enrollmenttracker where like when you
submit it, it doesn't just gointo the the the deep dark mist
(20:11):
of I hope I get an ID card in amonth and I hope I get coverage.
Like now you can, you know,just like a dominance tracker,
you can literally seeapplication submitted,
application reviewed,application you know issued,
here's all your you know,digital ID cards, here's all
that kind of stuff.
So that's where you know we aretoday.
No doubt it's gonna evolvetremendously over the next
couple of years.
And I will tell you the the thecarriers are into it, um, or at
(20:34):
least the the vast majority ofthem, you know, they are
building things out.
We are having some fantasticdiscussions with them just to be
able to provide insights on,hey, this is what the employees
this is the kind of plan they'relooking for.
You don't offer that, or hey,you're not even in the state.
How can we actually make surethat you get this coverage?
Or hey, your networks you knowaren't as good.
Like, what can we do toactually tie some of those
(20:54):
pieces together?
So the conversations there areexpanding pretty significantly,
and that's that's that's whereit's going versus where it is
today.
David Saltzman (21:02):
Well, and that's
that's kind of my last question
as we wrap up.
If you look ahead, let's saythree or five years, geez, we
used to be able to ask that ifyou look ahead 10 years, but now
you can't ask that questionbecause who the heck knows,
right?
That's right.
Chad Schneider (21:20):
Yeah, so um I
think that, and and and there's
several CEOs of some majorcarriers that you know think the
ICRA is going to be the futureof healthcare, and it's only
going to be growing moresignificantly.
So I would say look out formore data coming out from you
know, not only us, but HRAcouncils, NABIP.
You know, there's there's a lotof data out there, but where's
it going?
(21:40):
It's going to much moreintegrated systems, it's going
to more transparency, it's goingto better plans, it's going to
better networks.
It's going to be much more likehealthcare being localized, um,
being able to have anindividual plan, even though you
live in Florida, but whenyou're on vacation in uh Texas,
being able to actually havein-network coverage versus you
know, in-network, out ofnetwork, and all you know, those
(22:01):
types of things that are goingon, uh, additional perks that
employees are gonna be able tooffer.
So now a 10-life group is gonnaget some pretty cool perks, you
know, versus you only have tobe at a 500 life group.
I think those are you know alsowhere it's gonna be going.
The the integrations, the techis gonna be uh you know, really
fantastic.
And frankly, I think just thethe innovation around where
(22:22):
where how can I make sure thatthe employees are really getting
a much better handle on theiractual uh knowledge around
healthcare?
I mean, this is the equivalentof uh 401k in pension.
Um, obviously, I was probablythe last like class, uh you
know, I'm 44.
I was the last class to getlike a pension at my old company
years ago.
Um, the the the new hires don'teven know what the hell a
(22:44):
pension is, right?
And so uh I think this is theexact same way, where now you're
gonna have a better handle onlike your investment, your risk
profile.
You know, what am I actuallylooking at from like growth
rates?
Like this will be the samething, another you know, five
years, employees will actuallybe able to say, like, all right,
I I am healthier because ofthis, or I may have these
outcomes.
I've been able to use thesecool pre-nouveau body scans and
(23:07):
whatever else that are out therethat they'd never had access to
before.
So I think it actually is goingto be pretty innovative and
game-changing for the futurehere.
David Saltzman (23:15):
Chad, if people
want to learn more, what's the
best way to find out more aboutwhat you guys are doing?
Chad Schneider (23:20):
Yeah, uh, please
feel free to go to our website,
which is you know thatch.com,uh, reach out to me on LinkedIn.
I'd love to chat with you, andwe could happy happily go
through our process, quoting,you know, show you all the cool
bells and whistles, and youknow, we'd love to be able to
engage further.
David Saltzman (23:36):
Chad, thanks for
spending some time with us
today.
Chad Schneider (23:38):
My pleasure.
Always always great to see you,David.
David Saltzman (23:41):
Equally so.
Announcer (23:42):
The Shift Shapers
Podcast is a production of Shift
Shaper strategies and may notbe reproduced or quoted in whole
or in part without our expresswritten permission.
Copyright 2020, all rightsreserved.