BIP Fall 2024

FALL 2024

Official magazine of NABIP ENDURING LEADER How Gordon Award Winner Pat Griffey forged a lasting and inspirational legacy

+ ERISA TURNS 50: REFLECTING ON A LANDMARK LAW AND ITS MODERN-DAY IMPLICATIONS

+ NABIP ADVANCES THE FIGHT FOR TRANSPARENCY AND CONSUMER PROTECTION IN HEALTHCARE BILLING

FALL 2024

Official magazine of NABIP

NABIP Shaping the future of healthcare

Volume 71 No.2

EDITOR-IN-CHIEF Elizabeth Galentine elizabeth.galentine@contentovation.com

ADVERTISING SALES MCI (410) 584-1900 Danielle.lucifero@wearemci.com

focus 34 22 Five lessons in leadership Principles that have guided Pat Griffey’s remarkable career, from embracing leadership to fostering proactive collaboration. 28 50 years of ERISA Exploring the origins and evolution of ERISA, its impact on employee benefits and the ongoing challenges of fiduciary responsibility and compliance. 34 Shaping a transparent and affordable healthcare future NABIP drives for change in healthcare billing, advocating for transparency, eliminating surprise bills and creating a shoppable marketplace.

PRINTER Walsworth (573) 442 8714 www.walsworth.com

REPRINTS MCI USA (410) 584-1900 Danielle.lucifero@wearemci.com

MAILING ADDRESS 999 E Street NW, Suite 400 Washington, D.C. 20004

EDITORIAL & DESIGN ContentOvation with Therium Studio

www.ContentOvation.com jamie.green@contentovation.com

www.theriumstudio.com melissa@theriumstudio.com

The opinions expressed in this magazine are not necessarily endorsed by NABIP nor does the magazine assume responsibility for statements made in advertisements or published articles. Send editorial submissions to: BIP Editor, 999 E Street NW, Suite 400, Washington, D.C. 20004. BIP (ISSN 2475-5826, publication no. 238660), 2023, volume 71, number 2 Published 4 times per year (Spring, Summer, Fall, Winter) by the National Association of Benefits and Insurance Professionals, 999 E Street NW, Suite 400, Washington, D.C. 20004. $25 annual subscription price is included in NABIP member dues. Periodical postage paid at Washington, D.C. and additional mailing offices.

On the cover: photography by Cynthia Lynn

“ ”

inspiration

02 LETTER FROM THE CEO Jessica Brooks

Capping out-of-pocket costs doesn’t mean those costs disappear. — Michael Andel, VP of Congressional Affairs, NABIP

Woods reflects on one year at the helm of NABIP

6

04 LETTER FROM THE PRESIDENT

14 PROFESSIONAL DEVELOPMENT A powerful framework for transformational

The pivotal moment we face to unite and transform healthcare

06 NABIP IN ACTION Conduct effective legislator meetings;

leadership; fostering meaningful connections and growth through mentorship Weight loss drug coverage consider ations; how brokers impact Medicare star ratings; ERISA’s ongoing relevance

NABIP’s Medicare certification course

10 INDUSTRY

18 VOICES

22

INNOVATION Help clients navigate mental healthcare; the complex factors driving skyrocketing drug prices

action 42 HEALTHCARE IS LOCAL

Where in the World is NABIP? 52 THE MIDDLE MAN

Central New Jersey NABIP

chapter leads with innovative member engagement

Claims expert Mickie Caban secures client reimbursements

46 ONGOING

52

EDUCATION Jennifer Muehlhau sen positions herself for future growth by earning her REBC

48 ENGAGEMENT

28

Why agency owner Austin Eppinette chose to join NABIP;

Letter from the CEO

Forging ahead through passion, purpose and progress

As I reflect on the one-year anniversary of my tenure as CEO, I’m filled with gratitude for the meaning ful connections we’ve forged. We have an incredible legacy of advocacy, leadership and innovation to uphold — one I’m honored to learn from, contribute to and embrace to guide our association forward. As an association, it is essential to know what our competitive advantage is. It’s not just our strong government relations organization or our network ing capabilities; it’s the unparalleled passion of our members. Passion can’t be manufactured; it’s our driving force. While we can acquire new skills and knowledge, it’s this passion that sets us apart and propels us into the future of healthcare, shaping it in ways no one else can replicate. Traveling across states and cities throughout the U.S., I’ve committed to being present and hands-on. Understanding the urgency of now, I’ve sought to

connect quickly with you to build trust and unity. Our mission isn’t just to participate in healthcare but to lead it, setting ourselves apart and driving forward with a shared sense of ac countability and vision. Having spent much of my career in healthcare employer coalitions, I’ve seen the vital role we play — even in rooms where we weren’t even invited to join the conversation. When initiatives need to move forward, your expertise, hard work, deep understanding and exclusive connection to the broader healthcare ecosystem are relied upon. This makes us essential. The future lies in our ability to empathize and understand, ensuring no one is left behind. It’s our responsibility to develop the next genera tion of benefits professionals, creating a pipeline for the future. We must forge new partnerships and relationships, recognizing that we collec tively touch every life in this country, leaving no ZIP code behind. Your efforts facilitate 90% of covered lives, providing security and safety to families and communities. However, coverage alone is not enough. Even with an insurance card in their hand, many still feel under insured, and millions worry about their healthcare costs. This is a weighty responsibility we carry. As we enter open enrollment season, take a moment to acknowledge and recognize your essential role. We’re not merely aspiring to be essential; we are essential. It’s time the world understands our impact.

Through your efforts, people will share stories of how you’ve improved their health and lives, leading with principles and building a healthcare system that truly serves everyone.

“

We are not competitors; we are family,

fighting excessive healthcare costs, unsafe care, fear and regulations that don’t serve our communities.

”

Jessica Brooks-Woods CEO, NABIP

2 bip magazine Fall 2024

Nationwide Employee Benefits®

Easy and affordable employee benefits from a brand you know

Offer to protect the physical and financial well-being of your clients’ employees with group insurance plans from Nationwide. We deliver easy-to-quote, affordable employee benefits that enhance your clients’ suites of group benefits.

Nationwide Provide℠ This innovative supplemental insurance pays upon diagnosis rather than making employees wait until they’ve been billed for treatment. With coverage for more than 13,000 conditions, employees get paid quickly — which can help them cope with the financial side of their medical issue. Think of it as a bridge over their health plan deductible or a way to cope with hospital bills.

D 3 (D Cubed) D 3 is short for Data Driven Decisions. AccuRisk Solutions and Nationwide have partnered to offer this self funded health plan solution that offers small to midsize employers a data-transparent, cost-efficient and flexible medical plan with Nationwide’s medical stop loss protection. With D³, your clients can truly stabilize health premium costs from year to year.

Learn more about Nationwide Employee Benefits at nationwide.com/voluntarybenefits.

D³ is administered by AccuRisk Solutions. Medical stop loss coverage is underwritten by Nationwide Life Insurance Company, Columbus, Ohio. (CA COA #7032). In Hawaii, Louisiana and Oregon, the coverage is underwritten by Nationwide Mutual Insurance Company, Columbus, Ohio. Nationwide Provide is underwritten by Nationwide Life Insurance Company, Columbus, Ohio (GLBP AO L20), and is subject to underwriting guidelines, review and approval. Nationwide Provide is a limited-benefit policy; it is not a substitute for health insurance. A complete description of benefits, limitations and exclusions is provided in the certificate of insurance and applicable riders. Limitations and exclusions apply. All coverage is subject to the terms and conditions of the master group policy. Product availability may vary by state. Nationwide and AccuRisk Solutions are separate and nonaffiliated companies. Third-party marks that appear in this message are the property of their respective owners. Nationwide, the Nationwide N and Eagle, Nationwide Employee Benefits and Nationwide Provide are service marks of Nationwide Mutual Insurance Company. © 2024 Nationwide NSM-0379AO (03/24)

Letter from the President

Uniting our voices: Building a powerful healthcare future

We stand at a pivotal moment, with a rare chance to harness our collective strength and transform the healthcare landscape. As NABIP members, we may not typically hail from giant consulting firms, but I firmly believe that advisors, consultants and brokers can join forces to create a better healthcare system. The challenges we face are universal, whether our clients have 70,000 employees or 70. Benefits management, employee retention and soaring healthcare costs are battles every business fights. While solutions may differ, our core mission remains the same: to advocate for our clients and community. I am deeply committed to NABIP and to helping us all rise to our full potential as professionals. Throughout my journey, I’ve seen the power of collaboration — with large consulting houses, big

brokerages and NABIP members. The “secret sauce” may remain elusive, but one thing is clear: by uniting benefits advocates, we can amplify our impact, not dilute it. A shining example is our victory in repealing the Affordable Care Act’s Cadillac tax. When employers, consultants and brokers stood as one, we triumphed, demonstrating the power of our collective voice. From Fortune 50 giants to small businesses, we represented all. It often takes a major issue to unite us, but imagine the change we could drive with ongoing collaboration. With CEO Jessica Brooks-Woods at the helm and her invaluable background with the Pittsburgh Business Group on Health and the National Business Group on Health, we can tap into the power of large employers and consultants. It’s time to shift from reactive to proactive, to lead with a clear vision of what we stand for: transparency, data ownership and an accessible, affordable healthcare system. NABIP’s Healthcare Bill of Rights is our rallying cry, our guiding document. With this platform, we can forge powerful alliances with groups like the Society for Human Resource Management and other HR, broker and benefit associations. By finding common ground, we can drive real change. The future of healthcare is ours to shape. Let’s seize this moment, unite our voices and build a better future for our profession and the healthcare system at large.

It often takes a major issue to unite us, but imagine the change we could drive with ongoing collaboration.

“

Throughout my journey, I’ve seen the power of collaboration — with large consulting houses, big brokerages and NABIP members.

”

Alycia Riedl President, NABIP

photo by Cary Rothschild

4 bip magazine Fall 2024

NABIP in Action

Make your voice heard on the Hill Advocacy veteran shares six tips for effective meetings with legislators. Tim Kanter, immediate past president of the California Agents and Health Insurance Professionals (CAHIP), also known as NABIP California, has attended dozens of meetings with state and national legislators. What does it take for an effective meeting? An open mind, solid preparation and expecting the unexpected are excellent places to start, says Kanter, president of Get Benefits Insurance Services, Inc. in Thousand Oaks, California.

Kanter visits Capitol Hill.

1 Don’t be intimidated. “A lot of times people are nervous meeting with legislators — I know I was initially,” Kanter says. “But remember that the people you’re sitting across from are just like you. They just happen to serve in politics.” Kanter says that 90 percent of the time, the conversations go well, and the visits are positive — even when the legislator has a different position on the issue than the constituent. “They’re not your enemy,” he says. “They’re just people who have to make hard decisions, and our job is to try to make some of those decisions a little easier.”

2 Respect staffers just as much as members of Congress. Don’t be discouraged if you meet with a young staffer rather than the actual legislator. Staff are responsible for educating members and driving the priorities of the office. Kanter recently met with a staffer in the office of Sen. Alex Padilla (D-CA), who was interested in learning more about the impact of the recent Medicare rule. “We covered all of our Medicare talking points and then she started asking us questions,” he says. What was supposed to be a 15-minute meeting turned into a 45-minute meeting — an amount of time a constituent would never get with the actual legislator. “I’m an agency owner, and I have a large amount of Medicare clients, so I had a great opportunity to address some of her questions,” Kanter says.

3 Prep for your meeting. Before your visit, take time to read and understand the issue’s talking points. NABIP emphasizes the importance of speaking with one voice when meeting with legislators or being interviewed by the media. “Knowledge is power,” Kanter says. He warns that you’ll miss something if you try to wing it. And if you’re participating in a fly-in, get together with the people attending your meetings. “You need to sit down ahead of time and say, ‘I’m going talk about the role of the agent, you’re going to make the talking points on Medicare, you’ll do the small-group issues,’” he says. “Once you do that preparation, it’s really easy.”

6 bip magazine Fall 2024

NABIP California board members and Kanter meet with Sen. Butler.

Kanter and peers visit with Sen. Padilla’s staffer.

4 Don’t assume members of Congress understand all the issues they vote on. A few years ago, Kanter was explaining his role in delivering Medicare coverage to clients when his congresswoman asked a surprising question. “I said, as agents, we help people understand the difference between a Medicare Advantage plan and a Medicare supplement plan,” he says. “And she stops me and says, ‘Wait, what is the difference?’ This is my congresswoman, who is nearing Medicare age and is voting in favor of or against things related to Medicare Advantage or Medicare supplement plans.” Kanter pivoted and spent the next five minutes educating her on the basics of Medicare. “It was a great conversation, and that is what we can bring to the table during these visits,” he says.

5 Waive the flag of the role of the agent. Kanter says it is common to meet with staffers or legislators who don’t have a clue what an insurance agent does or understand insurance basics. “You’re often meeting with a staffer who is 22 or 23,” he says. “They went from being on their parents’ insurance to being on insurance offered through their job, but they don’t make any decisions about it. They knew what an auto insurance agent is, but a health insurance agent is a totally different world. “We have to explain to legislators that we’re walking our clients through some of life’s most critical decisions regarding their health and finances.”

6 Think of serve your clients. Through his volunteer leadership roles at NABIP, Kanter has attended dozens of legislative meetings over the years. He says he is active in advocacy because he views it as a way to serve his clients. “I can serve my clients by helping them pick a plan or deal with a claim,” Kanter says. “And I can also help my clients by meeting with their legislators and say, ‘Do not support that so my client doesn’t have an emergency medical bill,’ or, ‘Please support this bill so my client’s situation is a qualifying event for Medicare.’” advocacy work as another way to

Visit nabip. org/advocacy/ policy documents each month for timely talking points to use during meetings with legislators and their staff.

Fall 2024 bip magazine 7

NABIP in Action

NABIP launches user-friendly

If you operate in the Medicare space, you know that the Centers for Medicare and Medicaid Services (CMS) requires certification to sell Medicare Advantage Plans and Prescription Drug Plans. But did you know NABIP recently launched an updated program — designed by health insurance agents and brokers — to provide the required certification? This summer, NABIP began offering the PY2025 Medicare Advantage Certification. Charged with enhancing the course, John C. Parker, principal at Parker Agency in Niantic, Connecticut, drew upon his previous life as an

Medicare Advantage certification course The updated certification program simplifies complex regulations and ensures comprehensive understanding.

Elena Katkova / iStock

8 bip magazine Fall 2024

HR person tasked with employee education and training initiatives to ensure the MA certification process would be user-friendly and practical. “My focus was to try to get rid of as much ‘government talk’ as possible, and most importantly, make it easy for people to read so they can understand how this complex system works,” says Parker. The MA certification course has three units of study. Part one highlights the ins and outs of Medicare A, B, C and D. Part two addresses general guidelines for brokers and agents. Part three was not revised. It is provided in partnership with a Medicare training network program to keep course participants updated on fraud, waste and abuse. “Federal regulations can take 10 or 11 lines to explain something which, in plain

English, would only be one or two,” Parker says. With this in mind, he removed complex language and specific references to federal regulation codes to make the content as simple to understand as possible while still incorporating the many updates and changes to Medicare that came through this year. The $100 MA certification course meets all CMS requirements and has received approval from national and regional carriers. Continuing education (CE) credits are included for all 50 states. But how does the course differ from other options, like AHIP’s Medicare training? “It includes not only the ‘what,’ but also the ‘why,’” Parker says. “And, it’s presented in a format that is easy to read and easy for a person to remember.”

Visit nabip.org/ professional development/ medicare advantage certification for more information.

TIP: Questions about the certification?

Reach NABIP services staff weekdays from 9 a.m. to 5 p.m. EDT at (844) 257-0990 or through professionaldevelopment@ nabip.org.

Delmaine Donson / iStock

Industry Innovation

Be a mental health advocate Brokers have a role in helping clients access the continuum of care.

The legal landscape Most health insurance plans cover mental health, but the average American employee doesn’t realize it’s a covered benefit, Kennedy told attendees at NABIP’s Annual Convention. The first Mental Health Parity Act in 1996 affected large groups only and said if the plan includes mental health, there must be parity with medical and surgical benefits. In 2008, the Mental Health Parity and Addiction Equity Act expanded parity to Medicaid and CHIP. It established categories of treatment with care parity. Another major change came in 2010 with the Affordable Care Act, which defined essential health benefits. Mental health had to be covered by every ACA compliant plan, expanding parity into small-group and individual and family plans.“So now we have all commercial plans having to adhere to the Mental Health Parity and Addiction Equity Act,” said Kennedy. “Things must be comparable. You can’t restrict access to care based on the size of your network. You can’t require that you ‘fail first,’ meaning that someone must go through detox, go home and relapse before they can have access to inpatient treatment.” The case for comprehensive care But while mental healthcare is supposed to be as accessible

Eleven years: that’s the average delay from when a mental health symptom emerges to when treatment begins, according to National Institute of Health data. That treatment delay is only exacerbated by the fraud, waste and bad actors who have flocked to the system. Benefit brokers have an essential role as advocates for clients to

help ensure they have all the information they need to gain efficient access to the continuum of mental healthcare. It starts by understanding what the law requires, says Dede Kennedy, chair of the NABIP Mental Health Working Group and president of BenAssist Health Insurance Services, LLC, in Pasadena, California.

Olga Strelnikova/ iStock

10 bip magazine Fall 2024

“

We need to explain that there is the ability for a patient to step up and step down into other

as any other type of care, the reality is, “that’s not true,” said Kennedy. Recovery is a multi-stage process and not as straightforward as the solutions many carriers propose. “We see an awful lot of carriers coming forward with self-help and mindfulness apps, and that’s great for somebody that’s in the ‘healthy’ or ‘reacting’ categories,” Kennedy said. “But when you get into the ‘injured’ and ‘ill’ levels, it’s not going to give the treatment that’s truly needed.” While many brokers understand therapy and acute inpatient, there are myriad levels in the middle. And brokers need to not only understand the care continuum themselves, they also need to educate their clients about it, said Kennedy. “We need to explain that there is the ability for a patient to step up and step down into other levels of care,” she said. “And that full continuum of care bodes best for the most optimal outcome.” Care levels 101 For brokers to be effective in advocating for the care continuum, they first need to explain it to their clients. • Inpatient is the most acute stabilization, with psychiatry available. From there, the individual should be discharged and moved to residential. • Residential is a contained, safe environment for medication, group and individual therapy. “Indicators of a better-run residential facility are trauma-informed and evidence-based care,” Kennedy said. • Partial hospitalization is the next step down at six

school, so morning or evening programs are available. • Therapy can be one or up to three days a week before moving up to intensive outpatient. “Most of us have in our minds that therapy is once a week or once every two weeks, but that can be escalated at this level if the patient needs more support,” Kennedy said. “And then, of course, from therapy, there is early intervention and prevention.” Navigate the process Brokers can be a key resource to navigate the authorization and utilization processes for clients. “We need all NABIP members to learn this information so that we can be better advocates for our clients, our families, the employees and the average American,” Kennedy said. “Treatment works, but we need to do it strategically. We cannot let people be discharged without knowing where to go next. How do we get people from point A to point B when they’re not able to do it themselves? It’s the effectiveness of the advocates. You have a role in that.”

levels of care. And that full continuum of

It takes an average of 11 years from when a mental health

care bodes best. — Dede Kennedy

symptom emerges to when treatment begins,

”

according to the National Institute of Health.

to eight hours a day, and it will include psychiatry. On a once-a-month basis, therapists will run group and individual therapy to continue the kind of treatment the individual had started in inpatient and residential. • Intensive outpatient is typically two to four hours a day. Most people will pair it with working or attending

NABIP TAKES ACTION NABIP’s Mental Health Working Group is actively working to craft legislation around mental health benefits access based on what it has learned from stakeholders and evaluating legislation nationwide. The association is developing a course on mental healthcare fraud, waste and abuse. The curriculum will cover how to identify legitimate, evidence-based treatment teams and treatment facilities with good outcomes. “NABIP is being proactive, and it’s wonderful,” said Kennedy. “I want to thank the members of the Mental Health Working Group for your effort and for the ways in which we are going to make [mental healthcare access] materially better for American consumers.”

Fall 2024 bip magazine 11

Industry Innovation

How do you think the lack of transparency in the pharmacy system drives the cost up? Goodwin: So many PBMs are saying, ‘We’re transparent.’ OK, what does that mean? We’ve tried to say transparency means removing conflicts of interest, defining your commitments so that everyone that we work with can trust but verify what we are doing. That means we are only beholden to the people who pay us — the members and the clients. Removing those conflicts of interest, those misaligned incentives. Helping the end users understand what they’re getting, what they’re paying for, how much they’re paying, that type of transparency will help lower costs. When you know what you’re paying and how much you are paying, that’s when you can do better. Pfeiffer: A number of very good transparent PBMs are out there that you should be pursuing for your clients. Are they willing to show you literally everything they’re doing, every dollar that comes in and every dollar that comes back to them? Are they willing to do a one-year contract? Are they willing to skinny down the contract to something that’s rather simple? What’s the termination clause? Those PBMs exist today, but you need to seek it out. And if you don’t seek it out, somebody else is gonna seek it out for your client. How are you educating consumers? Brewton: What I do and what I empower agents to do is to educate beneficiaries and break

Why are drug prices so high? Four experts weigh in on the industry dynamics that are fueling costs.

Pharmaceutical costs have been skyrocketing, and understanding the main drivers behind this escalation is crucial to reversing the trend. Speaking in a panel discussion at NABIP’s Annual Convention, industry stakeholders addressed the factors driving pharmaceutical price increases and potential paths forward for greater transparency and affordability. Among the panelists were Amanda Brewton, owner of Medicare Answers Now, Ali Goodwin of TrueScripts, Bill Hepscher, founder of RxManage & Canadian Medstore, and Bob Pfeiffer with ScriptSourcing. What do you see as the No. 1 driver in escalating pharmaceutical costs? Hepscher: One of the reasons that we’re seeing costs go up so much is because we’re seeing massive advances in

pharmacology. We often want to throw the manufacturers under the bus; they’re charging way too much. I think the biggest thing that we need to look at is why, as Americans, are we paying $100,000 for a product, where in countries like Canada, England, Australia and New Zealand, those other countries are paying a third of that cost. The argument by the manufacturers has been, ‘But we need the money for research and development.’ My question is, when does the rest of the world start paying for that? Goodwin: The vertical integration that’s happening involves carriers owning PBMs, and it is becoming a monopoly. There’s no fair competition. When PE and VC money are pulling the strings, the entities that are supposed to be serving you are serving another master.

Ask PBMS: Are they willing to show you everything they’re doing, every dollar that comes in and every dollar that comes back to them?

Atlas Studio / iStock

12 bip magazine Fall 2024

it down into English. CMS government speak and plain language people-speak are totally different. Common basic terms like ‘deductible,’ the public does not understand what they mean. So, if they don’t know what a formulary is, they don’t know that you can take it with you to the doctor’s office. There’s thousands of different formularies out there. I try to help with education and breaking down the concepts so that seniors understand, ‘Hey, if this diabetic medicine is too expensive for you, you have six pages in your formulary of different options that you can choose.’ I think stopping bad legislation from happening is what this association is so darn good at. “ ” What do we do next? Pfeiffer: I’ll make a plug for NABIP. I think stopping bad legislation from happening is what this association is so darn good at. Because often we think legislation is gonna change the world, and it actually makes things worse. Brewton: Education is huge to any legislation or general advancement in this space. It’s really important when we talk with legislators that we understand that their main priority is their constituents. They have 9 million different topics that they need to understand, so they don’t know it like we do. You have to educate the legislator in plain language, then come back to why this is important. ‘It’s not just because it affects me in this way — it affects the senior or the beneficiary or the employer.’ The more you’re able to do that and the more that you talk about how it will affect their beneficiary, their constituent, whether it be good or bad, that’s how you get their attention.

New + Improved Client Ready Quote System ¨

ACCURATE FASTER CONFIDENT EFFICIENT

Designed with your business in mind, BenefitMall’s Client Ready Quote System (CRQS) is built with a robust and powerful quoting engine that leverages modern technology and 45 years of industry expertise. This ensures a seamless quoting experience that delivers accuracy, speed, and efficiency . Streamlined and simplified, our upgraded CRQS enables you to continue quoting with confidence and delivering clients exceptional service.

Schedule a demo today or log in to get started. CRQS

@2024 BenefitMall. All Rights Reserved.

Professional Development

The formula for transformational leadership

75% of whom said they struggled with accountability. “If you’re going to reimagine success, accountability has to be a part of it,” Giles said. “Account ability is the only tool that you have to help people maintain their integrity. Accountability says, ‘I am simply holding you to doing what you said you were going to do.’” Communication Unresolved conflict is a signifi cant barrier to success — and that’s why effective communica tion is so critical. Giles noted that communication should focus on a meaningful dialogue rather than converting others to our point of view. “How many of you have ever sat in a meeting and heard a bad idea introduced but thought you weren’t going to be the person to say something because you don’t want to cause conflict?” Giles said. “We say, ‘I’m not saying it because I’m being polite.’ But here’s the truth: Polite is another word for incompetence.” Conversational competence, Giles said, is the ability to have a discussion where there’s the potential for disagreement — a critical skill to have under pres sure. Her formula for conversa tional competence is to describe, acknowledge, review and engage. When engaging in a tough conversation, stay in the “descrip tion” space as long as possible. “Every piece of data you get goes through your filters — except the person you’re talking to also has a filter,” Giles said.

Values Values is the importance of under standing your “why” — the core reason that fuels you. “If you’re going to reimagine what leadership and success looks like, you have to be intimately affiliated with your ‘why,’” Giles said. “Your work is too important for you to question whether you should be doing it.” For people who have lost touch with their “why,” Giles said to reconnect by asking: • Why am I doing this? • Why do I care? • Why does it matter to me? Accountability Executing on the why requires accountability. Fostering a culture of accountability creates an environment where integrity thrives. Giles believes people find accountability difficult because they don’t like to fail or because they have false expectations. She cited a study of 2,500 senior-level C-suite executives,

Motivation feels good in the moment. But transformation is a lasting change that reshapes how people think, act and lead — and that is where the true power lies. Regarded as the “CEO-Mak er,” “DEI Professor” and “Cubicle to Corner Office Empress,” An nual Convention keynote speaker Dethra Giles is a workplace and career optimizer who advises orga nizations and individuals on how to chart their unique paths to suc cess. The four-time TEDx speaker shared her formula to navigate the complexities of leadership to achieve long-term success. “Psychology tells us that if you make things easier for people, the likelihood they will do it increases significantly,” Giles said. “And formulas make things easier.” Giles’ formula for leadership

Dethra Giles reveals her framework for reshaping leadership, emphasizing the importance of accountability, values and communication.

is VACR: • Values • Accountability • Communication • Rest/Repeat/Represent

14 bip magazine Fall 2024

Professional Development

The lifelong impact of professional mentorships

To avoid jumping to the interpretation phase too quickly, ask the other person to walk you through their process and ask questions. Acknowledge the simi larities without minimizing the differences. Another critical component to arguing with integrity is to be honest about what you know and don’t know. One of the most chal lenging parts of the formula is to examine the narratives you have accepted as fact. “There may be a critical piece of the conversation that you got wrong, even if it was from a reliable source,” Giles said. “Step into the shoes of the person you’re talking with to see if the narrative is true for them as well.” How many times do people agree just because they want the conversation to end? That’s not what success looks like, Giles said. “We will not succeed if we simply have people just going along,” she said. “That’s not success. That’s compliance. And if all we do is comply, we don’t get far.” Repeat, rest and represent To round out the VACR model, repeat, rest and represent the previ ous three steps — and then deter mine if it’s time to compete or col laborate. The African proverb, “If you want to go fast, go alone. But if you want to go far, go together,” is Giles’ guiding principle. “We often think competition and collabora tion have to be mutually exclusive, and they don’t,” Giles said. Why don’t people collaborate? Fear, vulnerability and short-term focus. “I don’t want to partner be cause I could win in this moment if I go after it myself,” she said. “But what is better for the long term? If you don’t figure it out, you’ll never go to the next level of success.”

A longtime NABIP member, it wasn’t until this year that Maria Irwin, director of benefits at Advanced Benefit Solutions in Driftwood, Texas, felt like she truly belonged. What changed

good fit. And quite frankly, it was a perfect fit,” says Mordo. No set format Although Irwin and Mordo talk monthly over Zoom, they’ve also met in person at Capitol Conference and the Annual Convention. “I’ve attended all of these conferences, and it’s really because of the conversations and the encouragement I get from Dave,” says Irwin. It’s not their style to create an agenda for their meetings. “We just free-wheel it. A good mentor will do far more listening than talking, and I’m a decent listener,” says Mordo. However, every mentorship is different, and the only ‘wrong’ way to do it is not to have one at all, says Susan L. Combs, president of Combs & Company in New York City — herself an advocate of meeting agendas. Speaking at NABIP’s Annual Convention, Combs shared a reflection sheet she uses to guide meetings. “I’m Type A, so I like to have structure with my mentorship,” she told attendees. Items on a typical meeting agenda for Combs include: • What is the current focus, chal lenge or concern? • What are the goals until the next meeting? • What is the status of annual goals? Be mutually beneficial Combs, author of Pancakes for Roger: A Mentorship Guide for Slaying Dragons , noted a study by The

her perspective? Joining The Leadership Mentor Program. Designed to provide new and current members with senior leadership support, the official goal of NABIP’s Leadership Mentor Program is “to develop the skills, confidence and executional ability of new leaders with the intent of future growth and alignment within the Association.” Unofficially, it’s been a window into the big-picture goals and values of the association, says Irwin, president-elect of the Austin chapter. That’s thanks to her mentor, David Mordo, principal of D Mordo Consulting, LLC, in Wilmington, North Carolina. “The information that Dave gives me from a national level, I can bring that information to the Austin chapter. So I feel like I bring a lot more to chapter meetings because of Dave,” Irwin adds. In the 4th quarter of 2023, the Leadership Development Committee paired Irwin with Mordo after both completed an application for the program. “They thought we would be a

Maria Irwin, director of benefits at Advanced Benefit Solutions.

16 bip magazine Fall 2024

If you purchased, paid, or provided reimbursement for some or all of the price of branded Lipitor ® or its generic equivalent, atorvastatin calcium, you could get money from a settlement. There is a proposed settlement in a class-action lawsuit filed against Pfizer Inc., Pfizer Ireland Pharmaceuticals, Warner-Lambert Company, and Warner-Lambert Company LLC (collectively, “Pfizer”) and Ranbaxy Inc., Ranbaxy Laboratories Limited, and Ranbaxy Pharmaceuticals, Inc. (collectively, “Ranbaxy”). The lawsuit claims that Pfizer and Ranbaxy unlawfully kept generic versions of Lipitor off the market, so consumers and third-party payors paid more for brand and generic Lipitor than they should have. Pfizer and Ranbaxy deny they did anything wrong. There has been a settlement with Pfizer; the lawsuit against Ranbaxy is ongoing. No one is claiming that Lipitor is unsafe. Who is included in the Settlement? You may be included in the Settlement if you purchased, paid, and/or provided reimbursement for branded Lipitor or generic atorvastatin calcium and fall within any one of the following definitions: Third-Party Payor Class (“TPP Class”) All entities that, for consumption by their members, employees, insureds, participants, or beneficiaries, purchased, paid, and/or provided reimbursement for some or all of the purchase price of branded Lipitor or generic atorvastatin calcium, in Arizona, California, Washington, D.C., Florida, Iowa, Kansas, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Montana, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Carolina, North Dakota, Oregon, South Dakota, Tennessee, West Virginia, or Wisconsin (the “Class States”), other than for resale, at any time during the period from June 28, 2011 through and until December 31, 2012. Consumer Class All individuals who purchased, paid, and/or provided reimbursement for some or all of the purchase price of branded Lipitor, in the Class States, without the use of a Pfizer co-pay card, from June 28, 2011 through November 29, 2011. All individuals who purchased, paid, and/or provided reimbursement for some or all of the purchase price of generic atorvastatin calcium, in the Class States, from November 30, 2011 through December 31, 2012. A more detailed notice, including the full class definitions, and who is not included, is available at www.LipitorAntitrustSettlement.com. What does the Settlement provide? Pfizer will pay $35 million into a Settlement Fund that will pay (1) money to eligible Class Members; (2) notice and administration costs; (3) service awards to the class representatives who brought the lawsuit; and (4) attorneys’ fees, costs, and expenses. The full text of the proposed Settlement Agreement is available at www.LipitorAntitrustSettlement.com. How can I get a payment? If you believe you are a Class Member and want to obtain a share of the Settlement Fund, you will need to complete and return a Claim Form. The amount of your payment will depend on the amount of Lipitor or AB-rated generic versions of Lipitor you purchased and the number of claims that are filed. The Claim Forms, and information on how to submit them, are available on the Settlement website at www.LipitorAntitrustSettlement.com. Claim Forms must be postmarked (if mailed) or received (if submitted online) on or before November 29, 2024 . The Court will hold a hearing on October 1, 2024 to decide whether to approve the Settlement, the plan for allocating the Settlement Fund to Class Members, a request for payment of attorneys’ fees of up to 34% of the Settlement Fund, plus costs and expenses, and service awards to the class representatives. You or your own lawyer may appear and speak at the hearing at your own expense. The Court may change these deadlines or the hearing date (and time). Check the website below for updates. Please do not call the Court or the Clerk of the Court for information about the Settlement. Want More Information? Go to www.LipitorAntitrustSettlement.com , call 1-888-831-7612, email info@LipitorAntitrustSettlement.com or write to Claims Administrator 54388, P.O. Box 2694, Portland, OR 97208-2694. The deadlines contained in this Notice may be amended by Court Order, so check the Settlement website for any updates. Please do not call the Court or the Clerk of the Court for information about the Settlement. YOUR LEGAL RIGHTS MAY BE AFFECTED

Human Edge that found business owners who received mentorship

increased their annual revenues by an average of 83% — that’s 67% more than those who didn’t. Whether participating in a formal mentoring program, cultivating informal mentors, peer mentors, subject-matter experts or even finding a surprise mentor along the way, it’s all about “intentionally reflecting on the people that are in your lives,” Combs said. For those who think they could benefit from a mentorship, Combs recommends asking yourself the following questions: • Why do you feel like you need a mentor right now? • Is there something that you’re struggling with? • What are you looking to accom mentorship through NABIP in the last six years. However, over more than 40 years in the industry, he’s participated in many, both formal and informal. He has two pieces of advice: One, listen more than you talk, and two, be open-minded. “Things in this association are changing and will continue to change,” Mordo says. “Please do not force your opinions on your mentee. Bright younger people like Maria and others have great ideas. The great thing about being a mentor is that I could also be a mentee.” plish, and how quickly? Teaming with Irwin is Mordo’s fourth formal

David Mordo, principal of D Mordo Consulting, LLC.

TIP: For more information or to sign up for yourself, visit nabip.org/ membership resources/ mentor program/ program information

Voices

Employers weigh coverage of weight loss drugs Plan sponsors once again face a rather expensive healthcare conundrum. By Scott M. Stevens

Three choices Most health plans only provide coverage for GLP-1 drugs with a diagnosis of Type 2 diabetes. A diagnosis of obesity absent of Type 2 diabetes generally results in coverage denial. Pharmaceutical Strategies Group’s Renee Rayburn has cautionary advice for those on the decision bubble about coverage. “At this point, it is unclear if these medications will lead to sustained weight loss that delivers health benefits,” he recently told FierceHealthcare . “From a health plan perspective, lifestyle resources (e.g., fitness program incentives, lifestyle coaching) are not as highly utilized but are the most effective for weight loss management.” It seems employers and payers have essentially three choices with respect to insurance coverage for weight loss drugs: 1. Cover these drugs with the hope and expectation that the result will be reduced healthcare costs. 2. Exclude coverage for these drugs, and instead take a “wait and see” approach to evaluate side effects and the cost versus benefit aspect. 3. Provide coverage subject to a strict set of protocols, similar to how weight loss surgery has historically been handled.

The prevalence of so-called “GLP-1 drugs,” prescribed ostensibly for weight loss, is causing many to question the cost versus benefit aspect of these drugs. GLP-1 drugs are showing promise on weight loss, but they have not been around long enough to evaluate their long-term side effects. And they come at a very high price point. GLP-1 drugs, or glucagon like peptide 1 receptor agonists, work by acting like a hormone that signals brain receptors affecting both appetite and food intake. There are two potential outcomes from these drugs: 1. Appetite suppression leading to weight loss. 2. Slowing down the stomach’s emptying of food to the digestive tract makes one feel fuller longer. Drugs on the market in this category (Wegovy, Ozempic, Trulicity and others) range in price from $8,000 to $20,000 per patient annually. You will likely recognize one or all of these drugs due to extensive (and expensive!) advertising campaigns promoting them. Additionally, drug maker Eli Lilly recently gained approval for a drug called Zepbound (tirzepatide), estimated to cost around $12,720 per patient annually.

Pharmaceutical consulting firm Pharmaceutical Strategies Group surveyed 180 health plan stakeholders in 2023 and found startling results: • Respondents differed on whether to consider these drugs as a “lifestyle issue” or treatment of a chronic condition. • 43% are providing insurance coverage for these drugs, while 28% indicated they may decide to cover them within the next 1-2 years. • 22% said they did not cover nor will they consider covering them. variety of companies devising customized, cost-effective and comprehensive employee benefit plans. Scott M. Stevens, RHU, CDHC, is a NABIP member, employee benefit broker and consultant at Dodge Partners Insurance. He works with a

TIP: It wasn’t all

that long ago that

the medical community officially recognized obesity as a disease. This would seem to rule out the widespread connotation that weight loss drugs are “lifestyle drugs,” as opposed to treating diagnosed disease states.

18 bip magazine Fall 2024

A holistic approach to beneficiary care

Brokers’ and FMOs’ role in contributing to Medicare Advantage star ratings has never been more vital. By Darwin Hale

1. Continuous education. Stay informed about Medicare regulations and plan benefits to provide timely information. 2. Proactive communica tion. Regularly check in with beneficiaries to address their health needs and ensure they are utilizing their plan benefits. 3. Advocacy. Act as an advocate, helping beneficiaries navigate the healthcare system and access the care they need. 4. Collaboration with providers. Work closely with providers to ensure beneficiaries receive appropriate care.

The Centers for Medicare & Medicaid Services (CMS) creat ed the Five-Star Quality Rating system to promote and reward quality, ensure accountability and give beneficiaries the tools to choose high-quality plans. One of the most important contributions a broker can make is setting clear expectations. This begins with a thorough under standing of the plan’s benefits and limitations, ensuring that beneficiaries are informed about what they are entitled to and how to access services. Brokers also play a crucial role in managing a “wellness portfolio” for each beneficiary that includes routine check-ups, preventive care and the manage ment of chronic conditions. By maintaining regular contact, brokers help beneficiaries navi gate the healthcare system. This improves outcomes and enhanc es the beneficiary’s experience. Addressing obstacles Brokers contribute to star ratings by addressing and preventing potential issues. These include: Proof of coverage. It is crucial that the member receives proof of coverage within 10 days of enrollment. This document is essential for accessing care, and brokers help verify this, ensuring

Dr. Darwin Hale is a NABIP member, CEO and founder of Advocate Health Advisors, advising independent insurance agents serving seniors, veterans and employers.

“ ”

members know how to use their member ID card. Access to prescription drugs. When changing plans, members may face delays in medication access. Brokers edu cate members on updating their pharmacist in real-time, ensur ing fewer disruptions. Timely access to PCPs. Timely appointments are essen tial. Brokers help members find network providers, secure rou tine appointments quickly and navigate network changes. This expertise helps avoid unneces sary urgent care or ER visits. Best practices for brokers To maximize their impact on star ratings, brokers should ad here to these best practices:

By maintaining regular contact, brokers help beneficiaries navigate the healthcare system.

5. Feedback loop: Encour age feedback from beneficiaries to continually improve their experiences. Brokers and FMOs, working together, significantly impact star ratings. By managing wellness portfolios and optimizing phar macy benefits, brokers contrib ute directly to the achievement of high star ratings.

Fall 2024 bip magazine 19