People Strategy Forum · 2026-07-01 · 44 min
Key moments - from our scoring
Substance score
54 / 100
Five dimensions, 20 points each
Chris Hamilton brings nearly two decades of corporate finance and insurance experience to explain the economics driving healthcare cost inflation. Starting from his background in M&A finance, Hamilton discovered a fundamental misalignment in the insurance industry: the Affordable Care Act limited insurers to 15% margins on premiums, so the four dominant carriers (Cigna, United, Blue Cross, Aetna - the "BUCAs") vertically integrated into pharmacy benefit managers, specialty pharmacies, clinics, and physician practices to capture profits through subsidiaries rather than premium markups. This creates perverse incentives where doctors owned by insurance companies prescribe drugs that those same companies profit from through their owned pharmacies. Mid-sized employers have no visibility into claims-level pricing, making healthcare their second or third largest expense with zero control. Hamilton argues the solution is for employers to stop trying to match Fortune 500 benefits packages and instead design something more valuable, distinctive, and unattainable elsewhere - fundamentally solving the root cause rather than accepting rising premiums as inevitable.
The ACA capped insurer profit margins at 15% of premiums, so the four dominant carriers (Cigna, United, Blue Cross, Aetna) vertically integrated into pharmacy benefit managers, specialty pharmacies, clinics, and physician practices to capture profits through inflated internal billing rather than premium markups. Since 15% of larger premiums generates more absolute profit, insurers have structural incentives to raise total costs.
Insurance companies own or control PBMs that mark up medication prices and capture manufacturer rebates. They often also own specialty mail-order pharmacies distributing the most expensive drugs, allowing them to inflate prices and capture those profits in subsidiaries while employers see only the net claims cost on renewal.
Chris Hamilton recommends designing benefits that are more valuable, distinctive, and something employees cannot easily get elsewhere - solving the root cause of rising healthcare costs rather than accepting premium increases as inevitable, ultimately freeing up employee wages that will be spent in the broader economy.
Only employers that partially self-fund get claims-level detail showing what was purchased and at what price; fully insured mid-sized employers receive no such transparency, forcing them to accept the insurance company's claim that premiums must increase based on claims ratios without seeing transfer pricing or subsidiary profits.
Major insurers bought or created subsidiary companies including pharmacy benefit managers, retail and specialty pharmacies, clinics, and physician practices, allowing them to bill themselves inflated prices internally and capture those profits as subsidiaries rather than as insurance premiums - justifying higher employer premium increases.
Our reviewer’s read on each dimension, with quotes from the episode.
The episode contains a genuine structural explanation of how the ACA's MLR cap created incentives for premium inflation and vertical integration, plus reasonably concrete stop-loss mechanics. However, a large portion of the runtime is backstory, analogies (gas prices), and general scene-setting that adds little incremental learning for a benefits-literate operator.
there's a provision in the Affordable Care Act that limits how much profit an insurance company can actually make on the premiums...Do you want that number, Sam, to be 15% of a million dollars or 15% of a trillion?
the most expensive part of cancer treatment is not the surgery to remove the tumor, it's the ongoing cancer infusions, the J-code drugs, the medications that are prescribed to members
The core argument - self-funded plans good, fully insured plans bad, insurers have conflicts of interest - is a well-worn benefits broker pitch that has circulated for at least a decade. The 'non-profit health plan' reframe is a decent rhetorical device but nothing that challenges a sophisticated operator's existing priors.
That's called a self-funded health plan. It's a self-funded health plan. So let's strip out as much of the waste and profit out of this as we can
when I started doing this 12 years ago, nobody was talking about it, and everybody said I was crazy
Chris Hamilton is a genuine practitioner with a finance background and 12 years running self-funded plans for clients ranging from 50 to 7,000 employees - real operating experience, not a thought-leader. However, he is a mid-market broker, not a CHRO or CFO who has implemented this at an employer, which limits the 'I did this' credibility.
I have clients that range anywhere between 50 employees that are self-funded, partially self-funded...probably my largest client is about 7,000 employees
I clearly saw there was a conflict of interest where they were catering to the insurance company, not what the client individually needs
The episode earns credit for concrete price comparisons (MRI $5,000 vs $500, hip replacement $60K vs $20K), specific stop-loss math ($50K attachment, $200K stop-loss premium, 30% rate cap = $60K worst-case), and market structure data (12 - 15 insurers pre-ACA vs 4 today). Most numbers are illustrative hypotheticals rather than named client outcomes, which limits the score.
an MRI might cost $5,000 at one facility or 500 somewhere else
In a self-insured plan, they're only gonna pay $200,000 for stop loss insurance...worst case scenario, 30% on $200,000 of stop loss premium is...6%
The host asks a few substantive follow-ups - notably 'But they can drop you, right?' which surfaced an important contract detail - and probes on company size thresholds and cancer-claim risk. However, the interview is overwhelmingly a frictionless platform for Chris's standard pitch, with the host mostly echoing agreement and adding no productive skepticism about self-funding downsides or selection bias in Chris's case studies.
But tell me in a self-funded plan, if you have a few employees that develop cancer, God forbid, I mean, so how is that gonna impact your situation?
But then they can, can they, but they can drop you, right? They can drop you
Computed from the transcript - who did the talking, and the words that came up most.
Are Your Benefits Training Top Talent to Leave? Healthcare costs continue to rise, and many employers feel trapped in a system that gets more expensive every year. In this episode of the People/AI Strategy Forum, Sam Reeve speaks with Chris Hamilton, Employee Benefits Practice Leader at Hotchkiss Insurance, about how organizations can rethink their benefits strategies to improve employee retention, create more value, and regain control over healthcare spending. Chris explains why traditional insurance models often create misaligned incentives and shares practical strategies that leading employers are using to design more effective and differentiated benefits programs. In This Episode: • Why healthcare costs keep rising • The hidden economics of health insurance • How benefits impact retention and recruitment • The advantages of customized and self-funded plans • Questions every employer should ask their broker • Strategies for creating more valuable employee benefits • How benefits can become a competitive advantage Key Takeaway Benefits should not simply be viewed as an expense.
Transcribed and scored by The B2B Podcast Index.
1 - > Sam: What if your benefit strategy is quietly training 2 - > your best people to leave, not because it's cheap, but because 3 - > it feels ordinary? 4 - > A lot of companies right now are dealing with a higher cost of, 5 - > of health insurance as well, and so we're gonna talk about 6 - > strategies about that today. 7 - > I'm Sam Reeve, CEO of CompTeam and host of the People Strategy 8 - > Forum. 9 - > This show is for founders, executives, and senior HR 10 - > leaders that want practical ways to attract, retain, and motivate 11 - > great people.
12 - > We focus on real levers behind performance, such as rewards, 13 - > leadership, culture, and in this case, we're gonna be talking 14 - > about benefits as part of the workforce experience that 15 - > experts use every day, and Chris is gonna take us through that 16 - > journey. 17 - > So Chris Hamilton is an employee benefits practice lead at 18 - > Hotchkiss Insurance. 19 - > Uh, Chris brings nearly 20 years of corporate finance and 20 - > insurance background, and he's focused on helping employers 21 - > improve performance and profitability through smarter 22 - > benefits design.
23 - > Chris believes that too many employers assume that they need 24 - > to compete head to head with big company benefits when a better 25 - > strategy is to design something more valuable, more distinctive, 26 - > and something that employees cannot easily get elsewhere. 27 - > So let's welcome Chris. 28 - > Hi, Chris. 29 - > Chris Hamilton: Sam, thanks for having me.
30 - > Looking forward to the conversation. 31 - > Thank you 32 - > Sam: Sure. 33 - > So, so Chris, I mean, I would just love to, uh, just first 34 - > dive into your backstory a bit, how you got into the, the 35 - > benefits business, helping employers select the right 36 - > benefits insurance for their people. 37 - > I know that you have some, uh, some roots in, in finance, so 38 - > how did that, uh, your experience in corporate finance 39 - > really set you up for this role?
40 - > Chris Hamilton: Yeah, it's an interesting story. 41 - > If you'd have told me 20 years ago this is what I'd be doing 42 - > for a living, I would've thought you were crazy. 43 - > I... 44 - > Yeah, so I, I started my career in finance, uh, working with 45 - > mid-size, and ultimately towards the end of my finance career was 46 - > working with, uh, large regional, national, and even 47 - > multinational companies.
48 - > was h- at, at that point I was helping companies, um, f-fund, 49 - > uh, acquisitions, mergers and acquisitions. 50 - > And w- uh, it turned out, as, uh, one of my clients was a 51 - > large national broker, who is somebody that I actually compete 52 - > against now in this business. 53 - > But they were a client of mine, and we were helping raise debt 54 - > and equity to help them continue their acquisition strategy 55 - > around the country. 56 - > And this was around the time that the Affordable Care Act, 57 - > AKA, uh, ACA or the, uh, Obamacare, a lot of the 58 - > institutional investors were worried that the changes in the 59 - > healthcare law were going to hurt their earnings, their cash 60 - > flow, and ultimately their ability to pay dividends and 61 - > repay debt and pay out, you know, um, cr-create a return on 62 - > that investment.
63 - > And so, uh, I sat through a couple of presentations, uh, um, 64 - > with th-these executives, and ultimately there was an evening 65 - > at dinner where the CFO was explaining how they monetize 66 - > clients and how the, how money is made inside of brokerages. 67 - > I thought to myself, wow, I, I, I understood the, the, the 68 - > metrics, the economics of the business, but I didn't really 69 - > understand what it meant when they're meeting with clients. 70 - > And I'm not gonna paint everybody with a broad brush.
71 - > Not every advisor out there, th- they're, they're not bad people. 72 - > But when you work inside of a large national organization, 73 - > the, the, the mandates are set at the executive level of the 74 - > types of programming that we'll do and the types of programming 75 - > that we won't, and how we're gonna monetize. 76 - > And so the way people get paid is important. 77 - > And for big firms, they try to aggregate business with large 78 - > national carriers because not only can they earn commission 79 - > and fees directly on that client's business, but they earn 80 - > massive, massive bonuses at the end of the year.
81 - > And that, in my opinion, just in this conversation with these 82 - > executives, I clearly saw there was a conflict of interest where 83 - > they were catering to the insurance company, not what the 84 - > client individually needs. 85 - > so as I thought about that, and, and mind you, at this point, you 86 - > know, I've got a degree in finance and economics. 87 - > I have an MBA. 88 - > But at that point in time, I was the person that it came time for 89 - > open enrollment, I would take my booklet and I would go to 90 - > friends of mine that were in the industry to say,"Help me 91 - > understand how this benefits stuff works It's complicated.
92 - > My, wait, uh, what's the difference between a deductible 93 - > and an out-of-pocket? 94 - > And how do I find a doctor in-network? 95 - > But wait, some of these costs go to deductible, but some of these 96 - > costs go to out-of-pocket. 97 - > Why doesn't it all make sense to me?
98 - > And this, I laugh about that now because of where I'm at now, I'm 99 - > actually teaching people how to use their benefits, how to 100 - > design the benefits properly, how to fund the benefits 101 - > properly. 102 - > it's been a complete 180 for me. 103 - > Uh, but what I realized very quickly, and people always ask, 104 - > "What's the cost? 105 - > Uh, what's the root cause of rising health insurance costs?"
106 - > the cost of healthcare. 107 - > Sam: Yeah 108 - > Chris Hamilton: is a mechanism that we use to pay for 109 - > healthcare. 110 - > If you look at how everybody that participates in the system 111 - > today, nobody wants healthcare and insurance costs to go down, 112 - > because that means they make less money. 113 - > The entire system is designed for costs to go up and everybody 114 - > pay more so that everybody makes more.
115 - > And I realized that in that d- at that dinner table, I realized 116 - > this system is just completely misaligned. 117 - > And what got me into this business was I thought to 118 - > myself, if somebody could solve for the root cause of the 119 - > problem, they'd be able to create a really good business 120 - > would allow, uh, that would do something really good for their 121 - > clients, which would allow those clients to do something really 122 - > good for their employees, which is lower costs, better benefits, 123 - > access to more care.
124 - > And to me, at that point, I thought,"This is a really big, 125 - > uh, economic issue. 126 - > It's a societal issue." 127 - > Sam: Yeah 128 - > Chris Hamilton: if we could solve this company by company by 129 - > company, we could actually create economic stimulus. 130 - > Because if you think about the average American, or the median 131 - > wage in America right now is, what, 63,$64,000?
132 - > And if you look at a lot of mid-sized companies, they, their 133 - > deductibles are three, four, five, maybe even$6,000 with- 134 - > once you factor in out-of-pockets. 135 - > That's 10% of somebody's earnings, plus what they pay for 136 - > premiums. 137 - > Sam: Yeah 138 - > Chris Hamilton: what I mean by this, if we design this 139 - > properly, we can reduce their out-of-pocket costs, we can 140 - > reduce their monthly premiums. 141 - > This is now money that if you put$6,000 back into somebody's 142 - > pocket, they're probably gonna do what?
143 - > Spend it, right? 144 - > Sam: Right 145 - > Chris Hamilton: They're, they're gonna buy cars, houses, 146 - > clothing, uh, patronize local restaurants and retailers. 147 - > I 148 - > Sam: Mm-hmm. 149 - > Chris Hamilton: real money at scale that can be put to work 150 - > inside of our economy.
151 - > And I, I had that thought, and I thought,"Okay, this is..." I, 152 - > I... 153 - > For the first time, I had a passion about something that I 154 - > was gonna have the opportunity to go build, and that's 155 - > ultimately, that's a long way around the barn, but that's how 156 - > I got into this business. 157 - > Sam: No, that's fascinating.
158 - > I mean, right now you're, you're right. 159 - > I mean, you're just looking at, uh, healthcare in the United 160 - > States. 161 - > I mean, it's a, it's basically a transfer of wealth from 162 - > employees and employers to the pockets of big insurance 163 - > companies and, and medical professionals. 164 - > And, and I think that, of course, um, um, you know, there 165 - > is a better way of doing that of...
166 - > And, and people have been working on this forever. 167 - > But so what, what have you discovered, Chris? 168 - > What is the better, better way forward? 169 - > Chris Hamilton: Yeah, so I think it's important to talk about 170 - > what's, what's happened really quick.
171 - > So to the 172 - > Sam: Okay 173 - > Chris Hamilton: listener, I, I meet with executives every day 174 - > all around the country, and when I start explaining what's 175 - > happened in our ec- our healthcare economy and insurance 176 - > economy really over the last 20 to 30 years, nine times out of 177 - > 10 people are shocked. 178 - > They're like,"Oh, I had no idea that's how this worked." I think 179 - > it's important just for the average listener to, to kind of 180 - > break down in a summary format what's taken place, because 181 - > it'll make a lot of sense to especially anybody that's in, 182 - > that understands business strategy.
183 - > So, i- if you think back 25, pre-ACA, pre-Affordable Care 184 - > Act, uh, uh, early 2000s, we had 12 to 15 different health 185 - > insurance companies. 186 - > Post-ACA to today, right, we're June of 2026, we've got four 187 - > major commercial health insurance companies that offer 188 - > health insurance to employers. 189 - > You can name them, right? 190 - > Just we call them the BUCAs or the Cubas, Cigna, United, Blue, 191 - > uh, Aetna, right?
192 - > The, not much competition, 193 - > Sam: Right 194 - > Chris Hamilton: right? 195 - > and I wanna talk, I'll, uh, let's talk about why that's 196 - > happened, right? 197 - > The, the Affordable Care Act was really complex. 198 - > There were, it shook out a lot of the weaker players, the 199 - > smaller players.
200 - > There was consolidation that happened, so each of these big 201 - > companies was able to go out and buy up other insurance companies 202 - > for market share. 203 - > But there's a provision in the Affordable Care Act that limits 204 - > how much profit an insurance company can actually make on the 205 - > premiums. 206 - > It makes sense. 207 - > don't want insurance companies taking all of our premium, 208 - > denying all of our claims, and making all of our premium as 209 - > profit.
210 - > of makes sense, right? 211 - > Sam: Mm-hmm 212 - > Chris Hamilton: but if you're a publicly traded company, which 213 - > most of these are, they report to shareholders, they've got to 214 - > show growth and earnings. 215 - > You're looking at each other around the table. 216 - > Do you wanna make 15%, which is, for large companies, that's all 217 - > they can make, is 15% of the premium in total.
218 - > So if they're taking in a million or a billion dollars of 219 - > premium, they've got to spend 85 cents of those dollars, 85%, on 220 - > our healthcare. 221 - > Do you want that number, Sam, to be 15% of a million dollars or 222 - > 15% of a trillion? 223 - > Sam: Yeah, you want it to be higher, right? 224 - > Mm-hmm 225 - > Chris Hamilton: Immediately, this initial domino that's 226 - > kicked over is this, uh, spiraling up of premiums, but 227 - > they've gotta have some place to spend the money.
228 - > So what do these insurance companies do? 229 - > They vertically integrated. 230 - > So they went out and bought healthcare companies that they 231 - > could use to excessively bill themselves to show that they're 232 - > spending the money, capture those profits in subsidiaries, 233 - > and have justification to raise premiums for employers. 234 - > Sam: Mm-hmm.
235 - > Chris Hamilton: you a few examples of where insurance 236 - > companies are doing that today, and some of that's gonna change, 237 - > but everybody's familiar with pharmacy benefit managers. 238 - > So what is a pharmacy benefit manager? 239 - > What do they do? 240 - > It used to be an independent organization that would go out 241 - > and negotiate drugs, drug pricing at pharmacies in between 242 - > manufacturers and pharmacies to make sure the insurance company 243 - > and their members got a benefit, the best price It's be- it's, 244 - > it's done the opposite now, where these have become pr- 245 - > middlemen that capture profit in the form of excessive pricing 246 - > for medications and rebates from drug manufacturers.
247 - > So it's a profit center for the insurance companies. 248 - > they've also vertically integrated into pharmacies, and 249 - > some of them own retail pharmacies that we walk into 250 - > every day. 251 - > The, the, the... 252 - > But they also own, um, specialty pharmacies.
253 - > So the most expensive medications aren't being 254 - > distributed at your local pharmacy. 255 - > They're coming from a mail order pharmacy that the insurance 256 - > company owns, and they can mark the price up and capture massive 257 - > rebates on many of these medications. 258 - > That's the leading driver of cost inside of a health 259 - > insurance plan are these specialty drugs. 260 - > But s- many of these insurance companies have gone even a step 261 - > further to clinics, facilities, even owning physician practices.
262 - > So you might go see a doctor that's owned by your insurance 263 - > company who prescribes a drug that the insurance company 264 - > prefers because they can make a bunch of money on it that's 265 - > being filled at a pharmacy that the insurance company also owns. 266 - > of it's being pushed back to the insurance company at inflated 267 - > costs, at your renewal, your broker shows up and says,"Well, 268 - > your, uh, your claims ratio is high. 269 - > The amount of money that the insurance company has spent on 270 - > your claims is, is, is elevated, therefore, we have to increase 271 - > your premiums because of your, because of this."
Meanwhile, 272 - > they don't break out how much money was captured in transfer 273 - > pricing and profits being captured into each of these 274 - > subsidiaries. 275 - > And we know this to be true because when you partially 276 - > self-fund a group, a, an employer, get claims level 277 - > detailed access to what's being purchased, what price is being 278 - > purchased, and you can benchmark that. 279 - > But if you're a mid-size or a smaller employer listening to 280 - > this, you don't get that level of detail, so you just have to 281 - > take as truth of gospel from the insurance company that, yep, 282 - > they spent a bunch of money, and yep, they're gonna increase my 283 - > premiums and no visibility.
284 - > Now name something in your, in a business, Sam, you're a 285 - > businessman, where it might be your second or third largest 286 - > expense in a given year you don't have visibility into what 287 - > you're buying, what you're paying, or the ability to 288 - > determine is it a fair price 289 - > Sam: Yeah, that's crazy. 290 - > I mean, it's, you have no, no control. 291 - > It's hard to, to, uh, run a business when you can't forecast 292 - > effectively, and it's just, yeah 293 - > Chris Hamilton: Yeah.
294 - > So, uh, that's the... 295 - > what we're seeing going on inside of the health insurance 296 - > model. 297 - > Something similar is happening inside of healthcare, which is 298 - > pre-Affordable Care Act. 299 - > If you go back to the late'90s, early 2000s, I'm just thinking 300 - > about my home market here, I'm in Dallas-Fort Worth, but you 301 - > could take this, uh, and, and the, the model, uh, is the same 302 - > in just about every major city in the United States.
303 - > There used to be three, four, five hospital systems that would 304 - > operate, and now you've... 305 - > in most markets you have one to two. 306 - > Some markets you, you only have one hospital. 307 - > Uh, I was meeting with an employer yesterday in Florida, 308 - > and in their city they have one single hospital, and their rates 309 - > continue to go up, and it's because that hospital...
310 - > This is where health insurance and healthcare tie together. 311 - > hospital systems have gotten so big, the insurance companies 312 - > can't afford to not have them in the network or they lose 313 - > employers. 314 - > Sam: Makes sense. 315 - > Yeah 316 - > Chris Hamilton: if, if you think about this, the really popular 317 - > hospital, 318 - > Sam: Mm-hmm.
319 - > Chris Hamilton: the, that hospital drops out of network, 320 - > all the employees are gonna tell the employer,"Change to a 321 - > different insurance company because our hospital is not 322 - > in-network." Well, the hospitals know this, and not only have 323 - > they consolidated to create these massive hospital systems, 324 - > but they've also vertically integrated. 325 - > They've purchased physician practices, primary care, 326 - > specialty practices, oncology, um, OBGYNs, uh, f- uh, imaging 327 - > facilities, surgical centers.
328 - > They... 329 - > th- the goal for hospitals is that no matter where you enter 330 - > their hospital facility, whether through primary care or a 331 - > specialist, they're gonna be able to take care of you 360 332 - > degrees. 333 - > "Whatever you need, we can take care of you here." Uh, if...
334 - > once you enter the system, they'll never refer you to 335 - > another hospital or another group. 336 - > They wanna own the patient experience, and that allows them 337 - > to do two things: monetize it at every step, but two, they're 338 - > that much more important to the insurance companies to not let 339 - > drop out of network. 340 - > And so they're partic- they're, they're actually contributing... 341 - > And I'm not saying hospitals are bad.
342 - > I wanna be... 343 - > ma- make this point very clear. 344 - > Hospitals are stuck between a rock and a hard place. 345 - > And I may be getting a little too deep, but this is really 346 - > important for people to understand, 347 - > Sam: Mm-hmm.
348 - > Chris Hamilton: in this political environment where 349 - > healthcare has become highly politicized. 350 - > I think all of us would agree we want the same things. 351 - > We want access to affordable healthcare, we want access to 352 - > doctors, we want access to medications. 353 - > Uh, these are important things that it's a bipartisan issue.
354 - > Now, the solution is, is different. 355 - > But anybody that's talking about single-payer Medicare for All, 356 - > you need to understand Medicare and Medicaid is why commercial 357 - > employers and commercial insurers, uh, insureds are 358 - > paying exponentially more every single year. 359 - > Because what the g- what hospitals... 360 - > If you look at some hospitals and, and some hospital 361 - > financials are, are public, y- many of them are 50, 60, 70% 362 - > government paid.
363 - > That means si- 50, 60, 70% of their patients are on Medicare 364 - > Medicare, Medicaid, military insurance like TRICARE, right? 365 - > The government doesn't negotiate. 366 - > The government dictates the pricing. 367 - > If you're a nonprofit, not, or, or not-for-profit, you're a 368 - > research institute, you take Medicare or Medicaid.
369 - > so you're, they're forced to take these patients at a, at a, 370 - > at a, a, a pr- a fixed price from the government. 371 - > There's no negotiation. 372 - > Well, there's been a lot of talk about cuts to Medicaid. 373 - > Uh, Medicare only grows anywhere from flat to 1 to 3% a year.
374 - > Meanwhile, operating costs of these businesses for hospitals 375 - > are going up 8 to 10% a year. 376 - > Doesn't take a mathematician to figure out that at some point 377 - > the profitability inverts. 378 - > And so if you can't negotiate with the government, and they 379 - > make up 50 to 70% of your payer mix or your patient mix, can you 380 - > negotiate with? 381 - > It's Blue Cross United, 382 - > Sam: Yep 383 - > Chris Hamilton: Aetna who is providing the insurance to 384 - > employers.
385 - > And so we're basically all as employers and employees paying a 386 - > hidden tax by the government based on the way they pay, and I 387 - > think that's important to understand because if we wanna 388 - > flip to a completely Medicare-paid system, and this 389 - > isn't the topic of conversation, but I think it's important to 390 - > insert it here because what I'm telling you right now, p- the, 391 - > the first switch is people say, "Well, we should just go to 392 - > Medicare for all.
393 - > That'll solve the problem." No, no, no, no, it's gonna make the 394 - > problem way worse 395 - > Sam: Yeah 396 - > Chris Hamilton: because you're gonna have limits of care, and 397 - > that... 398 - > Sam: Right 399 - > Chris Hamilton: that that's, that's, uh, that's, uh, that's 400 - > fear-mongering. 401 - > It's not 402 - > Sam: That's not...
403 - > I, I hear that from, uh, foreign, uh, employers a l- all 404 - > the time, and their, and their employees complain that, you 405 - > know, they have to wait six, six months to get in to see a 406 - > doctor. 407 - > And some of them in, in Canada get frustrated and then just c- 408 - > cross the border here to U- and pay out of pocket, uh, just so 409 - > they can get a, uh, an appointment before they die. 410 - > Chris Hamilton: Yeah. 411 - > Well, actually, I was on a show, uh, another show like this one.
412 - > Uh, a business owner told me the story of his dad who had been 413 - > diagnosed with cancer in Canada, they said it was gonna take 414 - > seven to nine months for him to be able to start his treatment 415 - > because they just didn't have either the budget or the 416 - > capacity to treat him, so he came to the United States. 417 - > He came into California and got treated, and l- miraculously, 418 - > you know, because he was able to get in in time, uh, w- was, was 419 - > cured.
420 - > So it's, it's not an easy problem to solve, 421 - > Sam: Right 422 - > Chris Hamilton: it's important to just let people know, as I 423 - > start explaining these things, it is a natural tendency for 424 - > people to say,"Well, screw this system. 425 - > Let's just go to single-payer." I think it's important... 426 - > There, there is some validity to having maybe a larger government 427 - > role or, or, or an optionality, but it's not gonna be the 428 - > solution unless there's a complete reform and overhaul of 429 - > the way the government pays for 430 - > Sam: Well, you just took us through a journey where the, 431 - > the, uh, the government tried to fix it.
432 - > The ACA plan actually created new problems, right? 433 - > So, so what do we, where... 434 - > Chris Hamilton: been 435 - > Sam: What's that? 436 - > Chris Hamilton: It might have...
437 - > There's, uh, I'm not a conspiracy theorist, but a lot 438 - > of people have a, an opinion that maybe that was by design 439 - > Sam: Yeah. 440 - > It's unfortunate. 441 - > Yeah, the, the, uh, uh, I mean, we're paying with, uh, playing 442 - > with people's lives here, so, so hopefully that's not the case, 443 - > but it wouldn't surprise me if there's some of that, uh, going 444 - > on. 445 - > But, uh, let's, let's switch the conversation back to, uh, what 446 - > you provide a- and to help employers actually figure this 447 - > out in a way that's gonna help them as, as an employer be 448 - > stronger and also help their employees get the care that they 449 - > need 450 - > Chris Hamilton: Yeah, absolutely.
451 - > Well, the, the number one thing, I'll go back to what I said that 452 - > got me into this business, is we've gotta understand what 453 - > drives insurance 454 - > Sam: Mm-hmm. 455 - > Chris Hamilton: It's claims. 456 - > Whether you're talking about homeowners insurance, and 457 - > nationally rates are going up on homeowners. 458 - > Why?
459 - > Because there's floods, fires, hurricanes, hail, catastrophic 460 - > loss. 461 - > In different parts of the country, insurers are paying for 462 - > that. 463 - > Same with autos, As these cars have gotten more expensive to 464 - > fix and people are having crashes, insurance rates are 465 - > going up. 466 - > The same exact thing is true for healthcare as healthcare costs 467 - > go up.
468 - > So medications, w- the, the, the prices that are paid by 469 - > insurance companies to go in to have babies, and surgeries, and 470 - > see doctors, all of those things in aggregate as they accumulate, 471 - > um, are- go up, we've gotta raise the price of insurance. 472 - > So the natural thing to s- to, to look at is are there things 473 - > that can be adjusted to not only minimize the cost or reduce the 474 - > cost, but in the process, can we create more access?
475 - > And, and it turns out the answer is yes, which is so 476 - > counterintuitive. 477 - > When you... 478 - > If we start talking about, um, particularly here in our 479 - > society, if you pay more for something, do you generally get 480 - > better quality? 481 - > And for, in a lot of situations, the answer is yes.
482 - > But healthcare is, it's like a, it, it, it's compl- It, it just 483 - > boggles the mind that highest priced things generally aren't 484 - > the highest quality. 485 - > In fact, when you look at data, if you look at the median price 486 - > of, of something, so you take a hip replacement, or a shoulder 487 - > surgery, or a baby birth, or a gallbladder removal, that median 488 - > price or just a click below the median price is where you're 489 - > gonna get the best quality providers.
490 - > Yeah. 491 - > Sam: Justine 492 - > Chris Hamilton: is that? 493 - > It's because they're typically doing, uh, the procedures at 494 - > scale. 495 - > So that's the, the hip replacement.
496 - > I had one of these in January of '20. 497 - > The h- the, the... 498 - > And I interviewed multiple surgeons before I did this. 499 - > The, the, the gentleman that I saw could have done this in his 500 - > sleep because he was doing 5 to 10 a week, and other, uh, 501 - > surgeons I talked to maybe did four or five a month.
502 - > Sam: Yeah. 503 - > Mm-hmm 504 - > Chris Hamilton: they're, so these, the, the highly skilled, 505 - > high volume providers, they're blocking OR- big blocks of OR 506 - > time. 507 - > They're, they have a ton of experience. 508 - > They've got this at scale.
509 - > They don't char- they don't necessarily charge as much, and 510 - > it's just a little bit counterintuitive, uh, to 511 - > Sam: Well, yeah, exactly. 512 - > And as, and as a, uh, a patient, who do you wanna see? 513 - > Do you wanna go see a specialist that's, that does these all day 514 - > long, or do you wanna go see somebody that does it once a 515 - > month? 516 - > Chris Hamilton: That's right.
517 - > That's right. 518 - > So the number one thing is how do we address the, the, the cost 519 - > of the care that we buy? 520 - > Uh, Sam, remind me, what part of the country are you in? 521 - > Sam: I'm in, uh, currently I'm in the, in the, uh, uh, Midwest 522 - > Chris Hamilton: Okay.
523 - > Um, so I'm not sure what gas prices are out there. 524 - > I was thinking, uh, I, I was gonna make sure you weren't, 525 - > like, in California or New York. 526 - > I'm in Texas, so, uh, right now with everything going on, gas 527 - > prices are up. 528 - > They're a high$3.
529 - > But if I was to say to you,"Sam, hey, um, you're getting ready to 530 - > go on a road trip. 531 - > I'm gonna sell you, uh, gas at $10 a gallon," would, would you 532 - > buy it from me? 533 - > Sam: Pretty expensive. 534 - > They'd have to be pretty desperate 535 - > Chris Hamilton: Right.
536 - > Because you can probably buy it right across the street from 537 - > where you're at right now for what? 538 - > What, what does gas run where you're 539 - > Sam: Yeah, I can go across the street and get it. 540 - > Yeah, I can get it for five bucks a gallon, right? 541 - > So half the price.
542 - > I 543 - > Chris Hamilton: Five. 544 - > Sam: currently. 545 - > Chris Hamilton: that's pretty high. 546 - > So 547 - > Sam: Yeah 548 - > Chris Hamilton: um, so, uh, basically I'm trying to charge 549 - > you double, 550 - > Sam: Yep 551 - > Chris Hamilton: you can pay half, you're pretty smart, so 552 - > you're gonna go pay...
553 - > If I offered you 10 or$15 a gallon of gas, you're not gonna 554 - > buy it because you know you can get it cheaper elsewhere. 555 - > The same thing is true for medications, and many people 556 - > realize this, or starting to realize this, that this 557 - > pharmacy's gonna charge me 15 or $50 for a medication that I can 558 - > get for 5 or 25 at a different pharmacy. 559 - > that's a question that I often get is why are ph- uh, drug 560 - > prices so different just going across the street?
561 - > Or why does one hip replacement cost$60,000 but I can get it 562 - > across the street for 20? 563 - > Or an MRI might cost$5,000 at one facility or 500 somewhere 564 - > else. 565 - > But think about the insurance experience. 566 - > Anybody listening to this has insurance, right?
567 - > If you've got insurance, you've got an ID card. 568 - > Does that ID card tell you where to go? 569 - > Sam: No, sure. 570 - > Let's 571 - > Chris Hamilton: card tell you what it's gonna cost?
572 - > Sam: No, it does not. 573 - > That's right. 574 - > So, so this- 575 - > Chris Hamilton: do you typically, when, when do you 576 - > typically find out when s- what something's gonna cost? 577 - > Once you've scheduled it, you've handed your card, and they maybe 578 - > don't even tell you what it costs until after you've had it 579 - > done.
580 - > Sam: Correct. 581 - > Yes. 582 - > Mm-hmm. 583 - > Yep.
584 - > And then you have to wonder why there's, uh, extra charges on 585 - > your bills that you didn't expect. 586 - > Chris Hamilton: That's 587 - > Sam: So there's a lot there 588 - > Chris Hamilton: So w- what if you built an insurance plan 589 - > vetted the market for your, your employees and their family 590 - > members and said,"Look- Here's the best quality, here's the 591 - > best price. 592 - > If you go here, we can waive your costs, meaning no copay no 593 - > deductible, no out-of-pocket cost.
594 - > Maybe there's a nominal copay, uh, but if you go somewhere 595 - > else, the costs increase based on lower quality or higher cost. 596 - > You're gonna share more of that cost if you go to higher cost 597 - > providers that are, that are lower quality. 598 - > You can a- that data's becoming available, and you can design 599 - > those plans. 600 - > So we wanna create incentives.
601 - > We wanna, uh... 602 - > I mentioned the health insurance system today as it is, the 603 - > traditional model, there's a lot of misalignment, inefficiency, 604 - > and conflicts of interest. 605 - > goal for employers is, can we create a system that aligns 606 - > everybody's interests, not just the insurance company with the 607 - > employer, but the employer to the employee? 608 - > Because at the end of the day, I mentioned that, that median, uh, 609 - > income of a worker, if you're able to save them$6,000 of an 610 - > out-of-pocket cost, that becomes very meaningful to them.
611 - > And when you talk about retention and recruitment and 612 - > retention, becomes very meaningful if they think to 613 - > themselves,"I'm being offered more money from another 614 - > employer, but they certainly don't offer the type of access 615 - > and cost mitigation to my family my current employer does." the 616 - > goal now is, let's design a custom plan that looks and feels 617 - > like what employees have always gotten used to, but instead of 618 - > doing something to an employee, and what I mean by that is, what 619 - > typically happens when insurance costs come in at renewal, so 620 - > rates go up 10, 20%, the employer's now figuring out, 621 - > "Okay, how do I get this premium increase down?
622 - > Well, I'm gonna increase deductibles. 623 - > I'm gonna increase the out-of-pocket. 624 - > I'm gonna reduce benefits. 625 - > then I also may shift some of the premium cost to the 626 - > employee."
So where they were paying$50 before, now they're 627 - > paying 60. 628 - > So they just got a 20% increase out of their out-of-pocket, or, 629 - > or their out of, uh, paycheck costs. 630 - > Those are doing th- things to the employee. 631 - > But when we think about doing something for the employee, 632 - > which is an important distinction, is we're gonna...
633 - > We'll, we'll keep your plan designs the same. 634 - > You still have your deductibles and out-of-pockets, but if you 635 - > wanna go see these doctors, you wanna go to these hospitals, you 636 - > wanna get, Mark Cuban Cost Plus, m- um, a lot of people are 637 - > familiar with what Mark Cuban's doing in the pharmacy world. 638 - > There are programs like that that you add to your benefits. 639 - > access those.
640 - > We'll give all that to you for free, because the insurance, 641 - > which is the employer at the end of the day, the, the insurance 642 - > company's saving money, we're gonna share that savings with 643 - > you by reducing your out-of-pocket. 644 - > Everybody wins. 645 - > The insurance company wins, the employer wins, the employee 646 - > wins. 647 - > Let's create alignment of incentives so that everybody 648 - > wants the same thing, which is access to care.
649 - > We don't wanna prevent someb- wh- what sense in the world does 650 - > that make to prevent somebody from getting the necessary 651 - > medication that can save their life? 652 - > Or if it's a chronic medication them healthy. 653 - > Nobody wins by denying that medication, not in the right 654 - > system if it's designed properly. 655 - > Let's make sure everybody has easy access to all that.
656 - > 'Cause I would tell you, somebody taking a basic 657 - > medication that's gonna keep them out of a hospital from 658 - > whether it's having a diabetic reaction or if it's having a 659 - > heart attack or a stroke, we should be giving that medication 660 - > to people because you save money downstream. 661 - > But let's just align this so that it works. 662 - > So that's, that, that's the summary of this. 663 - > Now, y- your, your next question's probably gonna be, 664 - > 'cause when I explain this to employers, they usually say, 665 - > "Okay, well how do I do that?"
666 - > Sam: Yeah 667 - > Chris Hamilton: great question. 668 - > you're in the traditional system, so what we would 669 - > consider a fully insured plan, I just described how insurance 670 - > companies make money. 671 - > They don't give you many choices. 672 - > Sign on the dotted line for your fully insured insurance plan, 673 - > and you're gonna get my network, you're gonna get my pharmacy 674 - > benefit manager, you're gonna get my pharmacies, and if I own 675 - > physicians, those are also gonna be there.
676 - > But I'm not gonna tell you which ones I own. 677 - > It's just gonna be up to luck and randomness that your 678 - > employees may walk in and see them. 679 - > It's a closed system. 680 - > And oh, by the way, Sam, I'm not gonna share any information with 681 - > you'cause I don't want you to figure out what I'm doing to you 682 - > or your employees.
683 - > I'm gonna hide it all behind this veil of secrecy. 684 - > Sam: Right. 685 - > That is not the way to go, right? 686 - > Chris Hamilton: When I just described that out loud, as I'm 687 - > saying it out loud, in what world does that make sense?
688 - > Some companies are spending a million,$3 million,$10 million 689 - > for health insurance. 690 - > Like, what world did we buy... 691 - > It's a division of many of these companies. 692 - > If you run a$5 million a year business, a service business, 693 - > and you spend 800,000 to a million dollars, think ab- as a 694 - > percentage of your revenue, that's a division of your 695 - > company.
696 - > But most people don't think of it as a division of their 697 - > company, and they certainly don't run it like a division of 698 - > their company. 699 - > So 700 - > Sam: Yeah, that's the, that's the thing is, is a lot of, uh, 701 - > employers treat, uh, insurance as, or health insurance as, as 702 - > something that happens to them. 703 - > You know? 704 - > It's, uh, something that they, they have to pay just to, to be 705 - > competitive, not aware of, of the options that exist in the, 706 - > in the marketplace.
707 - > Chris Hamilton: Right. 708 - > And so now the, now what I am teaching employers and 709 - > empowering employers is how to take back that control. 710 - > Sam: Mm-hmm. 711 - > Chris Hamilton: And if you work with an advisor like me, and it 712 - > doesn't have to be me, they're...
713 - > W- the thing that I am most encouraged about over the last 714 - > 12 years, when I started doing this 12 years ago, nobody was 715 - > talking about it, and everybody said I was crazy. 716 - > In fact, people in the industry mocked me. 717 - > Some people did, like,"Oh, there goes Chris, the guy that's gonna 718 - > fix healthcare." And the reality is the fix is out there, but 719 - > it's employers have to know how to access it.
720 - > They gotta go to the right people. 721 - > And the thing that's most inspiring and I'm most hopeful 722 - > about is there are an, there are armies of people just like me 723 - > all around this country, I collaborate with many of them, 724 - > that are doing this kind of work. 725 - > And, and so the, the, the answer is to an employer that wants to 726 - > take back control and get out of this rat race of just no data, 727 - > no transparency, being taken advantage of, to build their 728 - > custom plan.
729 - > And that's also, I call it a non-profit health plan,'cause 730 - > most employers are not offering health insurance for a profit. 731 - > A- and, and, and I, I do that intentionally, and then I tell 732 - > them, when, when I say that to an executive and they go,"Yeah, 733 - > that makes total sense. 734 - > We should be doing a non-profit health plan," I say,"Well, 735 - > great. 736 - > That's called a self-funded health plan."
It's a self-funded 737 - > health plan. 738 - > So let's, let's strip out as much of the waste and profit out 739 - > of this as we can, and let's do it properly,'cause you're 740 - > never... 741 - > Unless you're, um, Amazon or you're Walmart or you're Home 742 - > Depot, you're not truly self-funded. 743 - > There's always, always insurance behind there that stands behind 744 - > the, the employer.
745 - > There's a big misconception that self-funding is risky or 746 - > riskier, and in fact, mathematically, if you do it 747 - > properly, it's actually safer than being fully insured in a 748 - > Sam: So what, what size of, what size of organization is, is best 749 - > for a self-funded plan? 750 - > Chris Hamilton: W- well, uh, you know, 10 years ago people would 751 - > say if you didn't have, uh, more than 1,000, 500 to 1,000 752 - > employees, it wouldn't make sense.
753 - > We see employers s- uh, at 50, even slightly below 50 employees 754 - > on their plan that are doing it, 755 - > Sam: Okay 756 - > Chris Hamilton: um, nationally, uh, consistently. 757 - > and we have clients in that size ra- I have clients that range 758 - > anywhere between 50 employees that are self-funded, partially 759 - > self-funded, I'll use that... 760 - > Anyth- anytime I say self-funded in this context, an insurance 761 - > company that's gonna stand behind catastrophic claims, so 762 - > you're never, uh, at it alone.
763 - > You're never fully self-funded. 764 - > So we have clients that are at 50, and I, my, m- probably my 765 - > largest client is about 7,000 employees. 766 - > I'm not really competing in the jumbo, uh, you know, Fortune fi- 767 - > that's not my niche. 768 - > But that's a good range.
769 - > You know, 50 to 1,000 employees is probably really where our- 770 - > the majority of our business is. 771 - > Sam: Okay. 772 - > But tell me in a self-funded plan, if you have, um, you know, 773 - > a, a few employees that develop cancer, God forbid, I mean, so 774 - > how is that gonna impact your situation? 775 - > Chris Hamilton: Yeah, so the number...
776 - > Uh, in, in, in reality, in a self-funded plan, if it's 777 - > designed properly, you're actually gonna pay less when 778 - > somebody develops cancer, and you're gonna pay less w- if you 779 - > have a million-dollar prem- premature baby because, uh, 780 - > let's just use, um... 781 - > I'm gonna use just round numbers here, okay? 782 - > Um, somebody's paying a dollars in health insurance premium, the 783 - > company, right? 784 - > So between the employer and the employees, the total premium is 785 - > million dollars a year, and somebody goes in and develops 786 - > cancer, and it's gonna cost half a million dollars for one 787 - > person.
788 - > So let's just assume they were at a run rate that was gonna be 789 - > about$800,000 for their claims 'cause there's about a 20% 790 - > margin in there. 791 - > Well, now all of a sudden, because there's a half a million 792 - > dollar claim, insurance company's gonna come back and 793 - > say,"Well, we just spent$1.3 million on your healthcare 794 - > That's 130% loss ratio, right? 795 - > You just do the 1.
3 divided by the million. 796 - > now gotta give you a 50% increase to kinda get you back 797 - > in line. 798 - > That's 799 - > Sam: Mm-hmm. 800 - > Chris Hamilton: actually how the math should work, but that's 801 - > generally what they'll show you, is 130% loss ratio, we're gonna 802 - > give you a 40 to 50% increase to help cover,'cause that cancer 803 - > patient probably is not resolved in the, in that first year.
804 - > It's gonna be a 18, 24, 36-month battle, right? 805 - > Sam: Mm-hmm. 806 - > Chris Hamilton: So we know that's gonna be ongoing. 807 - > Well, you're in a partially self-insured plan, for an 808 - > employer of that size with a m- million dollars in premium, they 809 - > might take the first$50,000 of cost on all of their members.
810 - > that member that incurs or undergoes cancer treatment 811 - > that's half a million dollars, the company's only gonna pay 812 - > $50,000 for that claim, and the insurance company that stands 813 - > behind the employer, so your company, Sam, is gonna pay the 814 - > other$450,000. 815 - > We've just shifted the risk to somebody else. 816 - > Now, y- anybody listening to this is gonna say,"Well, what 817 - > happens at the renewal, though? 818 - > Are they just gonna increase my rates?
819 - > You know, if I pay... 820 - > In a, in a million-dollar plan, if I paid them 200,000 in 821 - > premium and they paid$450,000 of my claims, I mean, is my premium 822 - > gonna triple?" Well, this goes back to designing the contract 823 - > to protect the employer, if you do it right, it makes it safer. 824 - > you can put rate caps for renewals that, that linger for 825 - > in So I just mentioned an employer that's got about a 826 - > million dollars in premium.
827 - > In a self-insured plan, they're only gonna pay$200,000 for stop 828 - > loss insurance, so that's the insurance company that stands 829 - > behind an employer, okay? 830 - > Sam: Yeah 831 - > Chris Hamilton: They paid $450,000 in claims. 832 - > To just even get that right sized up, they've gotta triple 833 - > my premiums. 834 - > That's a 300% increase just to get it roughly on par with what 835 - > they've paid, right?
836 - > Sam: Mm-hmm. 837 - > Chris Hamilton: If you desi- There are many carriers out 838 - > there that will do this and guarantee that they can't 839 - > increase your premium any more than 30%. 840 - > Sam: Okay 841 - > Chris Hamilton: So you take $200,000 in premium, 30%, it's 842 - > only$60,000. 843 - > Sam: But then they can, can they, but they can drop you, 844 - > right?
845 - > They can drop you 846 - > Chris Hamilton: No, you get that in writing, too. 847 - > It's guaranteed renewable. 848 - > Sam: Mm-hmm. 849 - > Chris Hamilton: be dropped.
850 - > Guaranteed renewable. 851 - > So worst case scenario, 30% on $200,000 of stop loss premium is 852 - > what? 853 - > $60,000. 854 - > $60,000 of a million dollars in premium or total spend is what?
855 - > 6%. 856 - > So I just mathematically showed you how to make this cancer c- 857 - > claim at now more cost-effective. 858 - > Now, the other thing is, can we manage that half a million 859 - > dollar cost for tr- for cancer that cancer claim less 860 - > expensive? 861 - > And the answer is yes, the most expensive part of cancer 862 - > treatment is not the surgery to remove the tumor, it's the 863 - > ongoing cancer infusions, the J-code drugs, the, the 864 - > medications that are prescribed to members.
865 - > So we just talked about pharmacy one, it's$50 for the medicine, 866 - > pharmacy two, it's$25 for the medicine. 867 - > The same thing is true for these cancer medications. 868 - > And so there's different strategies they use to help 869 - > reduce the cost without changing the provider that the member's 870 - > going to. 871 - > You don't wanna change somebody's oncologist.
872 - > That's really important. 873 - > That's a very sensitive and intimate relationship with a 874 - > provider. 875 - > You don't wanna disrupt that. 876 - > But doesn't mean that we can't get their medications at a 877 - > better price and make sure that the member's getting exactly 878 - > what they need and we're paying less for it.
879 - > anybody that I talk to seems to think,"Yeah, that makes total 880 - > common sense." If it's gonna be $50,000 for this and you can get 881 - > it for 20 or 25 and it's the exact same medication from the 882 - > same maker, makes total sense. 883 - > Like, who wouldn't wanna do that? 884 - > So that just gives you a concept of where employers are going and 885 - > what they're doing with their claims to help reduce the cost 886 - > Sam: Mm-hmm.
887 - > So it's really making sure that, uh, you have proper contract 888 - > design and, uh, management, uh, going forward. 889 - > So it's not something that's... 890 - > A- and, and so there's questions that, that, uh, um, I, I mean, a 891 - > lot of employers are kind of tied to their broker. 892 - > Like, they feel like,"Oh, I've had a relationship with this guy 893 - > forever," and they, they're reluctant to kind of change or 894 - > switch.
895 - > But what are the, what are the questions that the, uh, employer 896 - > should be asking their broker to kind of get them on, on the 897 - > right path? 898 - > Chris Hamilton: Yeah, I, you know, I think that's a w- great 899 - > question. 900 - > I think the first thing you've gotta figure out is what type of 901 - > broker that you're working with, and I'm not trying to cast 902 - > stones in a glass house here, but I just wanna be transparent. 903 - > Because just like in any profession, it doesn't matter if 904 - > you're talking about plumbers or if you're talking about lawyers 905 - > or if you're talking about doctors, people have 906 - > specialties, what, what their niche is, what they're 907 - > passionate about, what they're good at.
908 - > There are multiple types of health insurance brokers out 909 - > there. 910 - > There are some that are just very much in the traditional 911 - > market. 912 - > They represent insurance companies, and they will go get 913 - > you quotes from those big insurance companies. 914 - > We do business with the big insurance companies even, but 915 - > surprisingly, people ask me,"Are you able to do business with 916 - > them as much as you talk about them?"
Yeah, they want volume, 917 - > and some people specialize in that. 918 - > But there are other people that have a niche to know how to 919 - > design these customized self-funded health plans like we 920 - > do, they know what to look for. 921 - > They know how to design them. 922 - > They know what to request.
923 - > They know what to demand for their employers. 924 - > They know how to gauge a, an employer's risk tolerance. 925 - > So you need to be asking questions around that. 926 - > So if somebody wants to find somebody that, uh, can transact 927 - > the type of work that I'm talking about, the questions you 928 - > should ask W- what's going on in the healthcare market that's 929 - > driving costs up?
930 - > What's going on in the health insurance market that's driving 931 - > costs up? 932 - > Okay? 933 - > And the reason... 934 - > I just explained it to the employer, now they know what to 935 - > look for.
936 - > You need somebody that can articulate what's happening at 937 - > the level I just gave you. 938 - > If they're, if they're saying what I'm saying to you, somebody 939 - > that is, that's definitely leaning in the right direction. 940 - > Now, the next question you ask, "Okay, now that you just 941 - > explained to me what's going on, what are leading employers doing 942 - > to solve that?" And they should be des- describing customized 943 - > plans that address the root cause, which is claims, 944 - > healthcare claims, and that'll tell you that you're talking to 945 - > somebody that really is staying abreast of what's going on in 946 - > the market and what to do about it.
947 - > I- if you talk to somebody, you, you'll get... 948 - > Anybody listening to this, there's somebody listening to 949 - > this right now that has gotten this response. 950 - > I had somebody on, uh, people on my team that were like this. 951 - > Uh, what's going on in the market?
952 - > "Well, it's just this, you know, there's, costs are going up and, 953 - > you know, it just, it kinda is what it is. 954 - > There's not a lot of choices out there. 955 - > We can shop these different insurance companies against each 956 - > other." Wrong answer.
957 - > Wrong 958 - > Sam: Yeah 959 - > Chris Hamilton: because the solutions have been out there 960 - > well over a decade, probably 15 years. 961 - > In fact, there are more and more hospitals and providers want to 962 - > work around... 963 - > They're wanting to work with employers that are doing what 964 - > I'm talking about because they wanna get rid of, they wanna 965 - > bypass the traditional insurance companies, and they're willing 966 - > to give better prices to employers and their health 967 - > insurance plans if you do it.
968 - > Trust me, the hospitals and providers, physicians are g- uh, 969 - > they're tired of insurance companies. 970 - > They hate it. 971 - > They've had to build massive bureaucracies internally, 972 - > billing departments, and, uh, um, um, appeals departments, and 973 - > just collections departments. 974 - > It's just become this massive apparatus that the, it's a, it's 975 - > bloat administratively.
976 - > It's waste. 977 - > It's creating waste in the system dealing with insurance 978 - > companies. 979 - > And anybody that's listening to this, if you've ever paid cash 980 - > for something, gone to a doctor and said,"Hey, uh, w- I know 981 - > with insurance my deductible is X and my out-of-pocket's Y, so 982 - > it's gonna cost me five grand. 983 - > If I paid you cash, what would you take for it?""
Oh, uh, we'll, 984 - > we'll, we'll give half the price or a third of the price." Sam, 985 - > what, what that's telling me is that they value the time value 986 - > of money, getting their money now, having to fight it, and the 987 - > administrative bloat is worth at least 50% off. 988 - > Sam: Yeah. 989 - > Chris Hamilton: pretty, pretty incredible when you think 990 - > Sam: It is.
991 - > I found that myself. 992 - > Yeah, it is crazy the difference. 993 - > Well, th- this, uh, you know, Chris, uh, this is, you know, 994 - > highly valuable. 995 - > I know our listeners out there are, are just eating this up.
996 - > So I know that you mentioned, uh, that you have y- y- you, uh, 997 - > have a YouTube channel, and, and so where, where can, where can, 998 - > um, leaders that are listening in learn more and, and find you? 999 - > Chris Hamilton: Um, yeah, so I, I create content. 1000 - > I create short form content on... 1001 - > I never thought I'd be on TikTok, but that's, yeah, I'm on 1002 - > T- uh, TikTok, LinkedIn, YouTube, just most of the social 1003 - > channels.
1004 - > The best place to find me gonna be my website. 1005 - > It's, it's Chris Hamilton, I-T-S Chris Hamilton.com. 1006 - > Uh, there's case studies there.
1007 - > There's access to, um, each of the social channels that I'm on, 1008 - > depending on what you're looking for. 1009 - > Long form content, I have a... 1010 - > It's not a podcast, it's more of a solo cast, where I'll take 1011 - > common themes. 1012 - > You know, what, what is a self-insurance?
1013 - > What's a TPA? 1014 - > What's a PBM? 1015 - > How to design custom benefits. 1016 - > I break that down in longer form content on YouTube.
1017 - > But the It's Chris Hamilton website will get you to any of 1018 - > the type of content or, uh, information that you wanna learn 1019 - > about. 1020 - > And if an employer's out there and they're just looking for a, 1021 - > a, a different set of opinions or eyes, uh, on the plan that 1022 - > they're running, uh, I'm happy to make connections. 1023 - > I've got literally, uh, counterparts of mine that I 1024 - > collaborate with in all 50 states, Alaska and Hawaii.
1025 - > So if anybody's wanting t- a local connection to be made, I'm 1026 - > happy to do that or, uh, provide advice, um, just as a second 1027 - > opinion, um, for anybody that's interested in something like 1028 - > that. 1029 - > Sam: Great. 1030 - > So for our listeners out there, Chris has helped us reframe and 1031 - > understand how benefits in health and welfare actually work 1032 - > and, uh, some of the flaws in the system and how they can be 1033 - > solved. 1034 - > So, uh, the big idea here is, is that if we navigate around 1035 - > these, these issues, retention, uh, for your employees can be 1036 - > enhanced by inc- by providing more valuable plans that are 1037 - > customized to their needs.
1038 - > So it comes into designing, uh, plans in, in those contracts 1039 - > effectively, and a person like Chris can make that happen. 1040 - > So, uh, we've heard that, uh, a, a lot of different issues here 1041 - > that, uh, I'd love to dive in with you in a, in a later time, 1042 - > Chris, but, uh, thank you so much for, for joining us today 1043 - > Chris Hamilton: Yeah, I appreciate you having me. 1044 - > I'd love to come back on if you wanna continue the conversation.
1045 - > Thank you 1046 - > Sam: Great. 1047 - > Thank you. 1048 - > And for our listeners out there, if this conversation gave you a 1049 - > new lens, uh, please follow the show and, uh, share this 1050 - > episode, uh, or, uh, visit our YouTube channel for other 1051 - > strategy insights. 1052 - > But, uh, uh, this is, this is, uh, very revealing on, on what 1053 - > you need to do with your benefl- benefit plan, uh, in the next 1054 - > review, renewal cycle.
1055 - > And so I implore you to go out there and, and, uh, reach out to 1056 - > professionals like Chris and his network. 1057 - > All right. 1058 - > Well, take care, and we'll see you next week on The People 1059 - > Strategy Forum.
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