SHRM26 Debrief · Compensation & Benefits · #2239

Future Proofing Your Health Benefits: A Panel Discussion on Multi Year Planning and High Performance Program Design

with Jaimie Jarvis

& Stephanie Porrino

& Chelsea Ryckis

▶ Watch on the SHRM portal ~81 min, distilled

self-funded health plansreference-based pricingfiduciary governance

"You should hope to get balance bills, because if you don't get them, the provider is satisfied with that ridiculous invoice they sent out that was paid."

What it was about

Employers can escape the reactive, ever-worsening healthcare renewal cycle by becoming true fiduciary governors of their self-funded health plan. That means unbundling the four moving parts (PBM, network, TPA, stop loss), demanding claims-level data, and only working with vendors who win when the plan wins, rather than passively renewing with the same carrier and broker year after year.

By the numbers

2026 Milliman Medical Index: 7.2% increase from 2025, ~$37,524 for a family of four

annual employer-sponsored healthcare cost for a family of four

Florida average PPO reimbursement: 346% of Medicare

comparison point vs. Hendry's 123% under reference-based pricing

Kalos: zero employee premium increases in 4 years

outcome of plan redesign

Key notes

Understand the four separate moving parts of any health plan (PBM, network, TPA, and stop loss) and manage or benchmark each independently rather than treating the plan as one bundled black box.
Demand to-the-penny claims data (not summary carrier reports) so you can identify trends, audit invoices, and make predictive/data-driven plan decisions.
Consider a network replacement / reference-based pricing model, which prices claims off a percentage of Medicare rather than accepting inflated hospital billed charges with a token discount.

The contrarian takeBalance bills should be viewed as a good sign, not a bogeyman: receiving them means the plan is challenging inflated provider invoices instead of passively paying whatever is billed. Giving employees $0-cost-share access to care, like free imaging or free Centers of Excellence treatment, actually lowers total plan spend. It drives utilization toward lower-cost, better-negotiated care and prevents costlier catastrophic claims.

Take this back Monday

Do this for your team

Email your broker asking for to-the-penny claims data, not summary reports. Their response tells you if they're the right partner.

Say this in your next leadership meeting

We're not just renewing our health plan anymore — we're separately managing the PBM, network, TPA, and stop loss so no vendor profits when costs go up.

Watch out for

Relying on a broker who brings only 2-3 BUCA carriers (Blue Cross, United, Cigna, Aetna) as "competition" each renewal instead of evaluating all four plan functions separately.
Accepting carrier claim summaries (top 10 drugs, one-page spend reports) as sufficient data instead of demanding to-the-penny, per-claim data.
Compensating brokers/advisors through commission tied to premium size, which incentivizes them to push risk transfer (the most expensive option) rather than risk avoidance or reduction.

Fun fact · Chelsea Ryckis

A traumatic brain injury during her college sports career derailed her plan to attend medical school — and led her to found Ethos Benefits instead.

If this landed, see these

↳ Go deeperThe Hidden Cost of Pharmacy Benefits: How HR Leaders Can Unlock 30–40% Savings Without Disrupting Employee CarePharmacy is the unbundled line item this fiduciary approach most needs you to scrutinize.⇄ The counterpointFuture-Ready Benefits: Balancing Cost, Care, and Employee ExperienceArgues cost and care aren't opposing forces, so smarter design beats vendor warfare.✦ The unexpected oneEmotional Intelligence Is a System Skill That Makes Work WorkSame fix, different domain: repair the system instead of swapping the surface layer.