Why benefit advisers anticipate a shift to healthcare consumerism | EBA


The dynamic between father and son is full of nuance. While knowledge and insight may pour down the family tree, sometimes there are disagreements and a yearning for independence. 

Such is the case for Joe Markland, the 60-year-old CEO of Nfor1, a Precision Benefits Company, and his 28-year-old son, Mike Markland, an employee benefits specialist who founded ATMA, a word that represents “self” within Hinduism. 

Joe first taught his son the ropes of advising when he was still an impressionable high school intern doing cold-calls. After attending the University of Massachusetts Amherst, Mike had professional stints with his dad’s company as well as ADP, Insperity, Silvia Group and Hilb Group. Now, as he runs his own organization in the Boston area, with his dad’s operation not far away, he appreciates the insight gleaned from the senior Markland. 

Read more: Employee benefits are inequitable — and it’s getting worse

“He keeps me informed on everything,” Mike says about his dad. “A lot of what we do is very cohesive, but there are certain things that we do a little bit differently and different types of responsibilities that we’d like to take on. So that’s what kind of made me go my own way.”

EBN spoke with the two benefits advisers about their vision for healthcare, technology and where they think the industry will be in five years. 

The following conversation has been edited for clarity and space considerations. 

Mike, you’re a millennial. What do your fellow millennials want in their benefits? And then we’d like for your baby boomer dad to weigh in.

Mike Markland, founder, ATMA

Mike: Health insurance is a check-the-box thing. They care more about the monthly cost than they do about the plan in terms of employee benefits that people actually value. In today’s day and age, a lot of it is about whether someone can work remote. For certain people, there is a college debt repayment program. Any health insurance payment just detracts from that. 

Joe Markland, CEO, Nfor1

Joe: Having a son in the business, you start looking at things in a different way. The value of an employee benefit to a 60-year-old paying $250 for a health insurance plan isn’t valued the same way as a 28-year-old paying the same $250 a month for the same plan. If the goal is to attract and retain talent, you have to look at all talent and ages and what’s valuable to those people.

Since their January 2020 creation, Individual Coverage Health Reimbursement Arrangements (ICHRAs) have been an advantage for employers with historically higher risk or higher cost medical expense trends.What role do you think ICHRAs will play in the future?
Joe: I’ve always been a believer that individual choice needed to be an option on the table. Everyone is trying to control healthcare costs. And today’s benefit brokers, most of them are attacking the symptoms. The ICHRA is attacking the root cause of escalating health insurance costs, which is the financing system and having a third-party choosing the plan for people. I think it is the foundation of the future of healthcare in America. 

Read more: As long as employers control employees’ healthcare, life-saving technologies will go underutilized

Mike: I kind of agree. Health insurance has been pretty much decreasing in value for the past 60 years, and I think a major reason for that is like my dad said: when you have one person that’s deciding for hundreds of people, that doesn’t allow consumerism to take place. There aren’t any actual market forces that are working on health insurance to drive it down and meet consumers where they actually want to be met. We’re already seeing the individual market starting to really compete. In about half the states it is stronger than the group market. 

How will technology impact the benefits business?
Joe: What mobile technologies have done is allow a personalization of almost anything. Between artificial intelligence or machine learning and access to information, we can improve our personal lives. Healthcare is definitely one of them. Tracking your finances is another. Mike: What technology is going to need to do in the future is help people with decisions and connect them with the solutions that they actually need. We’re seeing a huge increase in wearable technologies. I was at the doctor getting my blood drawn a couple hours ago. And part of the conversation was, I showed her my app that had all my data. I was like, what’s my heart rate? How many hours of sleep do I get? All of these things matter to people’s health.

Read more: It’s time to reimagine traditional employee benefits. Here’s how to do it

Where do you both think the business will be in five years?
Mike: You have large groups that are experience rated. They can maintain for a little, while they have healthy years. But a lot of the times when they’re saving money, they’re just kind of pushing the buck one more year down the road. And then that problem comes back next year with a vengeance. They’ve been doing that in the group insurance game for the past 60 years. The only way to really break the cycle is to stop analyzing them as a group. Once you have an unhealthy group, it’s a lot easier to disband the group than try to make the group healthier. I think eventually everyone’s going to be choosing for themselves and there’s not really going to be any group plans anymore. 

Joe: Those in the industry need to start saying, how do we fix a very broken problem? How do we stop just treating the symptoms and start treating the root cause? We’re going to reach a tipping point where the consumerism does take over. It may not be five years, but definitely within 10, we’ll have a 100% consumer-centric market. 


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