About Perry Braun, President & CEO
With approximately 40 years in the employee benefits and healthcare industry, Perry Braun serves as President & CEO of the Benefit Advisors Network (BAN) and the National Benefits Center (NBC).
Most recently, he was Alera Group’s Managing Director of Business Consulting. At Alera Group, Braun focused on a number of key initiatives, including working with agencies and regions to improve business performance contributing directly to stronger results, and partnering with the property casualty team to build a new premium finance program for Alera Group’s Property & Casualty partners.
Prior to joining Alera Group, Braun was part of the founding team that helped launch Alera Group in 2017. He was also BAN’s executive director for nearly 10 years before his stint with Alera Group. At BAN, he will be responsible for assisting privately held employee benefit brokerage firms improve their performance and profitability through best practice learning, sharing of knowledge, proven growth strategies, and enhanced operating efficiencies.
Earlier in his career, Braun was Vice President of Sales and Customer Relations at Medical Mutual of Ohio, and he served as Vice President and Chief Operating Officer at Consortium Health Plans. He also held senior-level positions with Blue Cross and Blue Shield of Ohio.
About Benefit Advisors Network (BAN)
Founded in 2002, BAN is an exclusive, premier, international network of independent, employee benefit brokerage and consulting companies. BAN delivers industry leading tools, technology, and expertise to member firms so that they can deliver optimum results to their employee benefit customers. BAN intentionally limits membership because of the highly collaborative interactions. For companies looking to join BAN, please contact Steve Yarcusko at [email protected]. For more information, visit: www.benefitadvisorsnetwork.com or follow them on LinkedIn.
Medical Travel & Digital Health News (MTDHN): Please share an overview of your background and current activities in healthcare benefits.
Perry Braun (PB): I have spent almost 40 years in the industry, basically in three areas. I first began my career with an insurance carrier, then moved to consulting and now, for the last 27 years, have specialized in change management and creating organizations that are on performance and excellence.
I’m currently the owner of an independent business, Benefit Advisors Network (BAN), helping shareholder of privately held employee benefit brokerage firms improve their performance and profitability.
MTDHN: Do you serve international companies?
PB: We currently have clients in Puerto Rico and Guam, and we’ve received some interest from agencies in Portugal, Spain and Australia.
What we do is agnostic to where an agency currently resides because we’re focused on improving their business.
In a way, we take a generic approach. Once we understand their market, we are in a much better position to help them tailor their strategies and work on their execution to improve the business model.
MTDHN: From your experience, background and your work with brokers, where do you think the market is going in terms of finding centers of excellence (COE) that meet the needs of a particular group of employees?
PB: I think the concept of centers of excellence makes sense, particularly from an academic perspective, because you’re really focusing on leveraging the medical care experiences similarly defined as a production environment.
The principle is that the more you do of any one thing, the better you get.
For example, if a hospital specializes exclusively on cardiac care, it’s reasonable to assume that they’ve done thousands of cardiac procedures. Through repetition and dedicated effort, you gain experience and achieve higher-quality outcomes.
There is some interest in taking advantage of that expertise and experience because it lessens the residual cost of healthcare: You’re working with people who have done it a thousand times with much better outcomes that result from the quality of work performed. The academic aspect of this is that it’s a good thing and it should be leveraged more widely.
MTDHN: Does COE location matter? How do you think access to COEs has evolved over time?
PB: I think that transportation and the infrastructure to get to different places in the country (let alone the world) continuously improves.
If we trace the history of centers of excellence programs, the challenge of transportation and getting to the location has become far less of a barrier.
The second challenge is information. If we remember the pre-internet days, it was extremely difficult to communicate with employees about these types of programs and where they were located. Now, information is easily accessible, empowering individuals to learn and innovate regardless of their geographic location.
It has also become much easier from the centers of excellences perspective to distribute information about programs and what they do. I think we’re in a far better place now to connect with these centers of excellence.
MTDHN: Is employee adoption a challenge?
PB: Yes. This is the one barrier that still remains — having patients or employees move out of their comfort zone of believing that their medical care should be delivered locally. However, I believe they’re becoming more accepting and willing to travel elsewhere to access care.
I think we’re looking at developments in virtual medicine or telemedicine today as another example of employees getting outside of their comfort zone. They have a local mindset and I think it’s going to continue to some extent.
The real key is, can these centers that report to be excellent at what they do make their information consumer friendly — less focused around science, less focused around technology and make it more outcomes based? The COEs need to be much more consumer friendly so that consumers can understand the information that they’re getting and act upon it in a better way.
MTDHN: If you look at one heart or cancer center versus another, are we looking at the doctors? Are we looking at their outcomes? What are some benchmarks that consumers and employers should be examining?
PB: I think there’s really two.
For the most part, patients don’t necessarily draw a clear distinction or line between the physician and the facility. I think for the most part, when they’re exploring or they’re investigating, it’s the potential outcomes that are driving the decision.
They’re looking at the facility in total. I think the facility would do itself a favor to focus on outcomes, specifically highlighting physician and nurse teams that have demonstrated a high level of expertise through the volume of patients they have treated.
To me, it’s always outcomes. It is less about cost and price. The focus is on having a good outcome. I think patient testimonials and patient stories are far more impactful than some of the science and data points.
What is compelling is a blend between the data and the patient stories. You want people to say, “I want what they got. I want that outcome.”
I think that’s what we all aspire to receive as patients — to receive a good outcome when we visit a medical facility because we know that somebody else through their story has received a good outcome. That third-party validation carries so much weight.
MTDHN: The patient experience is a primary driver for the consumer. How about from the employer standpoint? Should they be looking at cost and quality? Can they balance that? Do they relate to infection rates or readmissions?
PB: I believe employers do have some opportunity to provide information and help their employees and dependents learn where medical care can be effectively and efficiently delivered.
I think we’re still trying to understand the relationship between cost and quality as it relates to the medical center. President Trump’s most recent executive order on transparency and others before that invites insurance companies and provider health systems to publish their pricing,
This is yet another step in the ongoing evolution of highlighting the cost of a particular service. Consumers can have a better opportunity to make a decision that is more blended between cost and quality since they are the ones who are purchasing the services.
If we trace against where the history of the insurance plans or the benefit plans that these employees are using today, we’re finding that employees are absorbing more of the front-end costs through these higher deductible programs that seem to be the norm today. With the employees absorbing more of the initial cost, employers could consider incentives to drive the employees to consider or use Centers of Excellence.
In that mindset, if employees are absorbing most of the cost upfront, I believe we should do what we can to help them be better consumers and better purchasers of healthcare. Give them the information which is both price or cost of a service and the outcome results that they should expect as a patient.
MTDHN: Do you believe that incentives to use these centers of excellence is appropriate? For example, absorbing the copay or waiving the deductible to incent an employee to go to a particular facility?
PB: We’re all motivated by what we can save or what we spend as part of the decision process.
I think that incentives are unique tools. In some cases, employers have used these in order to incent people to go to a lower price facility or lower price service. I would balance that strategy of waiving copays and deductibles and other sort of out-of-pocket expenses by not just focusing on the lowest price.
But I would say I would feel comfortable directing or incenting somebody to use a high quality, high outcome facility even if it was a little more expensive because of the benefit to the employee, both short and long term.
MTDHN: How can brokers help their clients to make these decision about centers of excellence? Should they be looking at a national network? Should they be looking at a local hospital? How can they help their clients make these decisions?
PB: I think this is where the artistic and the scientific part of the brokerage industry come together. The art lies in creation, while the science is in the data that justifies why you’re doing what you’re doing.
In each situation where data is available, I would look at what the cost drivers are within the medical plan and then explore what options exist on either a direct contracting basis with a particular facility or through a national association or network of these facilities — if one is available.
I would let the data drive what and how to change the direction of cost and the outcome for the employee and the employer. I think it’s reasonable to assume that there are certain medical costs and medical conditions that are just high in expense.
We can point to leukemia, cancer, or other resource-intensive diseases and generically apply a centers of excellence mindset in some decisions. But in certain cases, there may be other opportunities based on unique claims that an employer’s population is driving.
The process should be the same: identify it and then determine where and how to best execute on that, possibly beyond your geographic location as a potential way to solve for it.
MTDHN: For the providers, hospitals and networks reading this newsletter, what is their best channel to connect with brokers?
PB: There are a couple of different ways.
First, there’s been a lot of aggregation and consolidation within the brokerage industry. There are also the larger, reputable regional firms out there, not just national corporations and conglomerates.
Most every firm has some sort of contact or hospital/industry representation or specialty practice that they should be reaching into, highlighting and promoting.
Again, I think there are other ways in which brokerage agencies are consolidating. They are participating in membership groups, such as Benefit Advisors Network (BAN). We could also be a partner in the distribution of information regarding that particular healthcare system. Additionally, we could also be a party to help contact these brokers and then leverage those relationships. Obviously, you have the insurance carriers themselves promoting it.
Second, brokers are receiving industry information through a variety of different sources.
Last but not least, there are trade associations that represent the brokerage side, for example NABIP and CIAB. These are also effective third-party groups to distribute information on behalf of the medical centers and health systems. These organizations are positioned to promote and highlight what the health system is doing and reach a brokerage community.
MTDHN: Do you think that brokers are open-minded to international medical travel?
PB: I think they’re open-minded to any and all opportunities to effectively change the cost structures for their employers.
As I look at medical tourism or getting care through a foreign country, the cost associated with travel is a fairly significant impediment to address. I also think medical centers in foreign countries have to work a little bit harder at dealing with whatever the perceptions might be of somebody traveling to that country to seek medical care.
There is some inherent bias when we think about another country and its medical systems that the facility needs to recognize and then address in the process of attracting patients. Again, it’s all about patient outcomes, patient testimonials as well as cost history. These are all important facts to put out there.
If possible, there should be some ways to make travel easier and ways to overcome some of the challenges a person or a family might face in trying to reach a destination.
MTDHN: Let’s pivot for a moment away from medical-surgical procedures to accessing pharmaceuticals – especially specialty pharmaceuticals and in particular, high-cost infusion therapies- outside the U.S. Where do you see that going?
PB: I think the industry – particularly the PBM industry — has received its appropriate share of negative press over the past five years.
But I believe opportunities to participate in importation programs for medicines have been overlooked, particularly 90-day maintenance drugs to be shipped from third-party countries at a significantly lower cost because of the pricing strategies in those countries.
Canada, for example, is one country that imports some to the United States and there are companies that specialize in this service.
I also think that the policy makers in our country are going to take a hard look at the pricing of pharmaceuticals in the United States. You may remember the Biden Administration had specifically targeted seven or eight medications to introduce price controls. I personally think that the intended outcome is to establish a price for those under Medicare and Medicaid.
There are also some public health programs such as the 340B Drug Pricing Program, a government program that allows hospitals and clinics to purchase discounted outpatient drugs from manufacturers. This program creates some pricing advantages for those populations that cannot afford some of these medications. There’s also manufacturer coupons and rebates.
Currently, there are many different tactics to address the high cost of prescription medications and I think brokers have been adapting to what the PBM industry and pharmaceutical industries have been doing.
But there’s still more to go – a long way of saying, “Can people go buy medication in Mexico and would it be cheaper?” The answer is “Possibly,” but I’m not so sure that the cost of travel offsets the savings attributable with lower priced drugs in Mexico — unless it’s really some of those higher expense medications and infusion therapies that we’re talking about.
When a person requires regular infusions, the cost of travel on a repeated basis may not generate material savings. Then there is also the consideration of time away from work and family.
I think it’s complicated but I believe medical tourism for accessing medical care, particularly non-emergency or routine plastic surgery, has some benefits to the patient.
MTDHN: Now let’s talk about ex-pats. Do brokers have any have any responsibility or commitment to helping companies assist their employees living all over the world to find the highest quality care?
PB: For the expatriates that are overseas and living full-time in certain countries, brokers can implement both a strategy and set of tactics or executables to help expatriates find and get medical care.
There are currently a number of air ambulance and air transportation companies that can help people receive care back in the US or care in different countries if necessary. There are certainly networks out there that can do that.
Yes, I do think brokers can develop — or develop when asked — a strategy to handle the expatriates. These employees are very important assets for the employer. It is valuable to have someone overseas representing the employer’s interests, acting as management personnel to make sure that their product or service is doing well in the country where it is being developed.
This activity is quite expensive and employers want to protect and help their assets. Brokers will get involved in that process. Again, it just depends on what you’re trying to solve for — what’s the problem, what’s the solution.
I think this is where the brokerage community is good for clients. They’re as much artists as they are scientists, and they can create some wonderful and unique solutions once they understand the problem they’re trying to solve.
MTDHN: This last question is a little bit of a hot potato. Should brokers be looking at centers of excellence that are funded through private equity?
PB: I think how the health system is organized and how it is funded is part of a broker’s analysis.
What’s really important is what the outcomes-based data is telling us about that particular facility and its positive patient outcomes. What are the patient testimonials that can reinforce that?
If the facility is competitively priced with very good and positive outcome results, it’s an interesting conversation whether it’s a not-for-profit or whether it is privately-owned. I think the central question is not how it is organized but whether the facility produces a quality outcome at a competitive and effective price.