All posts by Bill Carew

About Bill Carew

Bill Carew is a managing principal for Ovation, a Digital Benefit Advisors Company. He is a healthcare entrepreneur and business leader with a passion for innovation, leadership and personal growth. With a tight knit group of partners, he has launched and grown four successful businesses, all of which have been positioned as innovative market leaders in mature industries. Bill attributes his success and personal satisfaction to being part of a forward-thinking management team that thrives on new challenges and allows him to regularly re-define his day to day responsibilities to focus on new and emerging opportunities. By continuously adapting to the changing needs of the business and the marketplace, he and his team remain personally energized and highly engaged in the growth and day to day operations of businesses. Bill is a member of the Metro-Hartford Alliance Healthcare Council and Chairman of the Wellness Committee, a frequent presenter to industry trade groups, and an active contributor to business and industry panels influencing the direction of healthcare policy and legislative activity. Bill has a BA in History from Boston College and an MA in Economics from Trinity College. Bill is a past recipient of the 40 Under 40 Award by the Hartford Business Journal, a member of the Northwest Catholic High School Board of Directors and immediate past Chairman of Nutmeg Big Brothers Big Sisters. Bill resides in Simsbury, CT with his wife Karen and their four children.

Insanity or a Winning Strategy? What’s Your Game Plan?

Navigating the changing landscape of health care with new ACA rules and regulations can be overwhelming for benefit decision makers, but inaction or repeating the same actions is ineffective or maybe even insane. Albert Einstein famously defined “insanity” as “doing the same thing over and over again and expecting different results.”

For some employers, health and benefits are considered “necessary evils,” and their health care strategy is often a reactive, repetitive and last minute process that involves:

  • Reviewing their health care renewal 90 days or less from their renewal date
  • Getting competitive bids to use for leverage in negotiating their health care renewal
  • Changing carriers every year or two to save money
  • Reducing benefits to reduce cost
  • Increasing employee contributions to reduce the impact of increases
  • Dabbling in wellness programs and hoping employees participate and get healthier
  • Rolling out changes during open enrollment and making the best of a bad situation

The cycle repeats itself nine months later. We call this a “Groundhog Day Strategy” in honor of the Bill Murray movie where every day is a repeat of the prior day, and it doesn’t work. Continue reading Insanity or a Winning Strategy? What’s Your Game Plan?

Healthcare.gov Rocky Start Won’t Mean the End of Obamacare, But Carrier Losses Might


It’s hard to sugarcoat the fact that the launch of Obamacare and the healthcare.gov website has been an unmitigated disaster, and there are few of us in the industry who are surprised.
However, there have been many rocky product and website launches before, and Obamacare too will survive this administrative debacle. With a little time, a ton of money and the undivided attention of the Commander in Chief, the website will get fixed sooner rather than later. There is far too much for the President to lose politically for the administrative problems to persist.

The fact is that administrative problems don’t bring down big ideas.  But financial problems do.

That’s why the White House is fixated on the ratio of enrollments, not the total number. The fact of the matter is that low enrollment will not kill Obamacare, but the mix of healthy/unhealthy might.

healthcare.gov

The number one selling point with Obamacare is the elimination of pre-existing conditions – the fact that people who need health insurance can get it when they want it without massive premium surcharges. But remember that insurance is a game of subsidy – the law of large numbers is based on the fact that you need healthy people to subsidize the unhealthy. In order to afford to cover the unhealthy without a financial surcharge, you need lots of healthy folks willing to pay a surcharge.

You need lots of healthy folks willing to pay a surcharge.

2.7 million of them, to be exact.  With 7 million people projected to join through public exchanges, underwriting assumptions require 40% of the enrollment to be age 35 and under in order for the premium structures to work.  Without these healthy folks, carriers will lose money and rates will go up dramatically.

So what happens if the young and healthy don’t enroll?  First, risk management provisions of the Affordable Care Act step in to absorb insurance carrier losses that exceed 103% of premium, up to a maximum of 108%. Carriers will then increase their premiums accordingly so then can make some money. So on the surface, there is no reason to expect carriers will drop out of the exchanges right away.

But they might.  ACA regulations require that carriers maintain a single risk pool on and off exchange.  Losses on the exchange will hurt the competitiveness of carriers off-exchange, by law.  So while the government will help to absorb underwriting losses, carriers need to worry about exchange losses infecting their entire book of business, and their ability to compete in the market.  Losses on exchange will increase prices off exchange as well and could result in carriers losing membership. They won’t like that at all.

So pay attention.  If the young and healthy don’t enroll, things could start to unravel fast.

Employers Must Remain Focused Despite Delay of Employer Mandate

The recent decision by the Obama administration to defer the “employer mandate” until 2015 has virtually no impact on the vast majority of “large” employers currently offering health insurance programs to their employees:

  • Most employers currently charge employees less than 9.5% of salary for coverage;
  • Most coverage currently being offered meets the definition of “minimum actuarial value”
  • Most employers were planning to continue to “play, “not “pay”

So for almost all large employers, the mandate didn’t mean a thing… so its postponement doesn’t mean anything, either.  Essentially, nothing has changed… including the challenge ahead:

  • Premiums will continue to go up;
  • New taxes, fees and regulations will add to the cost burden;
  • Providers are consolidating and shifting more and more cost to private insurance plans;
  • The obesity and chronic disease epidemic continues unabated;

Which means that employers need to remain focused on developing and executing a clear and focused strategy to manage healthcare costs in the new world of the Affordable Care Act.

For most employers, these strategies should still fall into one of three major categories:

  • “Pay”:  Transfer responsibility for providing coverage to publicly subsidized coverage through the public exchanges.  This strategy is generally reserved for small business and certain non-profits and other lower-paid industries (the postponement may make this option even more attractive).
  • “Play Passive”:  Transfer responsibility to employees through a hands-off cost management approach.  Utilize private exchanges to facilitate a defined contribution strategy where employees assume responsibility for choice and a growing burden for future cost increases.
  • “Play Active”:  Aggressively manage costs through self-insurance, incentive based contributions; consumerism and leveraging higher allowance for outcomes based wellness plans.

health-care-reformBottom line? Don’t get distracted.  We have to expect that there will be many more twists and turns in the road ahead.  If you’re an employer responsible for navigating the new world of healthcare, you have got to stay focused on implementing your new strategy—by investing the time and the energy to chart the best course ahead for your organization. Do that and you will stay ahead no matter how the rules of the game are changed.

Live, Protect, and Strengthen the Brand

I have always been infatuated with the power of strong brands.   Since we started this business 10 years ago, we tried to build an organization—and a brand—that reflected who we were as individuals and what we thought our customers valued the most:

– Integrity
– Service
– Creativity
– Commitment
– Innovation
– Excellence
– Positive Energy
– Passion
– Personality

I learned to appreciate the power of the brand by working with branding guru Tom Lanen of ThomasBoston, who taught me about brand equity and the need to constantly and continuously protect and preserve and strengthen your brand.  “Protect it at all costs,” Tom said.  “Be true to yourself—and true to the brand. Always.”

At first, we focused on building the brand through traditional marketing.   We focused on the tools we use to tell our story, things like our name, logo, tag-line, website, collaterals, etc.  And we built a solid foundation.

But Tom also taught me that you build equity every day with every little decision you make along the way, which sounds simple and easy.  But if you are growing, how do you continuously protect and preserve and strengthen the brand when more and more people get involved?

That’s where brand becomes culture.

We are in the service business, and our brand is really our people.  We have built our brand by building our culture to attract the people who reflect our values and our priorities in the market: integrity, service, creativity, commitment, innovation, excellence, positive energy, and passion.

We have been very lucky to attract the right people.  But we’ve been purposeful as well.  It doesn’t happen by accident.

It’s been almost 10 years now, and I think we’ve done a pretty good job. When people think of Ovation, they think of these qualities.   And that makes me proud of our brand, and proud of our people.

Thanks, Tom.