Health Insurance Needs To Come Out Of The Box

We always hear about “Out Of The Box” (OOTB) thinking that brings new ideas and innovation that brings change to many ways of life that we have traditionally become accustomed to. Methods become obsolete or outdated, inefficient and ineffective, unproductive, or become financially noncompetitive.

The same holds true with health insurance. Today’s model with insurance companies continue to produce the same ‘ol results:

  • no innovation to access care – we still utilize PPO networks that have been ingrained to us for decades
  • no alternative methods to control costs – costs continue to rise which makes PPO discounts irrelevant
  • the big behemoth insurance companies continue to post record profits each quarter
  • drug prices continue to rise at an unbelievable rate, especially Specialty Drugs

Employers need to approach health insurance like everything else they purchase in their company. Health care is the only thing that we purchase in this country that we don’t know the price of the service or services BEFORE we receive care. Employers wouldn’t purchase anything for their company without knowing the price and simply settle on a bill from a supplier 90 days later!

Why is that? It’s because the insurance companies and medical providers don’t want things to change! They are very comfortable with the status quo. Why would they want to change something that is going to reduce their profits and their way of life?

That’s why employers need to employ brokers/consultants who think OOTB and bring real solutions rather than delivering renewal increases from the insurance companies every year. In order to think OOTB those brokers and consultants need to challenge and disrupt the status quo within their own organizations – the very agencies they work for – to offer more competitive programs to their clients. Those insurance agencies aren’t going to like it either, because they get heavily compensated by the insurance companies whose programs they’re selling to employers. Wait! What? Brokers are supposed to be working for employers but getting compensated by selling an insurance program? They aren’t being paid by their clients but rather the insurance companies they’re working for!

OOTB thinking and implementation of health insurance programs has begun years ago and you need to think OOTB. It looks like this:

  • Eliminate PPO networks and give open access to employees for all providers
  • Eliminate ineffective PPO programs that don’t control costs – PPOs help expedite higher provider pricing. Implement Reference Based Pricing that actually controls pricing and does so year after year.
  • Eliminate the behemoth insurance company programs and unbundle your plan with Best In Class vendors.
  • Implement independent, cost effective Pharmacy Benefit Managers that will reduce drug spend, and explore independent Specialty Drug vendors.

There many more OOTB programs that we’ve implemented for our clients that are very effective in controlling costs. Our clients average ~28.5% lower costs than their employer counterparts that are still “In The Box.”

If you want to learn more about OOTB thinking and innovation, reach out to me at or call me at 970-349-7707.

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Frank Stichter