A Crucial Ally For Fiduciary Committees
In the complex world of healthcare benefits, an Advocate Adviser is a fiduciary committee’s friend and key resource. They ensure participant needs are prioritized, especially when costly treatments are involved. since this is where participant and plan interests can often collide.
An Advocate Adviser is the fiduciary committee’s compass pointing toward the True North of participant interests.
The Advocate’s Impact
Advocate Advisers, often former patients, bring firsthand insight into healthcare’s pitfalls and how healthcare decisions can cause harm.
Advocates champion participants, using expertise and experience to find solutions that benefit everyone. Fiduciary committees often face pressure from service providers to cut costs on expensive treatments. These companies do not typically have a fiduciary duty to protect participants.
Consequently, their recommendations can delay care, harm participants, and expose the company to legal risks. Advocates can help identify, evaluate, and communicate innovative solutions to participants. This approach boosts compliance, cuts costs, enhances benefits, and engages employees.
Participant Interest vs Plan Interest
ERISA mandates fiduciaries act solely in participants’ best interests. Many committees misunderstand this requirement, seeing their role differently.
They often act as if their duty is to protect the plan’s interests. As such, the Advocate must play a transformative role within fiduciary committees helping them adopt a Participant Interest Mindset and view decisions through this lens. Beyond compliance and empathy, it aligns plan and participant interests for better benefits, lower costs, and satisfied employees.
Key Aspects of the Advocate’s Role
To capture the essence of the Advocate’s responsibilities, we thought about Ann and all the qualities she brings to her clients. Since she personifies the role, we landed on using the the word ADVOCATE as a guiding framework:
A – Accountability: Ensures all parties, including plan sponsors, fiduciaries, and service providers, act in participants’ best interests.
D – Diligence: Helps the committee stay informed on industry best practices and carry out all activities with care and prudence.
V – Value: Prioritizes maximum value for participants in all decisions, balancing both short and long-term benefits.
O – Oversight: Monitors plan operations and performance to identify potential issues and recommend corrective actions.
C – Connect: Fosters open communication and engagement with participants to ensure their voices are heard and concerns are addressed.
A – Align: Seeks alignment between participant and plan interests, promoting a collaborative and mutually beneficial approach.
T – Trust: Helps the committee build and maintain trust through transparent and ethical conduct, acting with integrity and honesty.
E – Educate: Enables informed decision-making, providing fiduciaries and participants with clear information about plan alternatives and costs.
Key Takeaways
- Expertise + Experience. Advocates are essential for ensuring the best interests of plan participants are upheld, especially when service providers may prioritize cost-cutting over patient care. Their professional expertise and personal experience can help identify potential harms and find solutions and benefit everyone.
- Participant Interest Mindset. Fiduciary committees and members can often misunderstand their role, acting as if their duty is to protect the plan rather than the participant and beneficiary interests. Advocates can guide these committees to adopt a Participant Interest Mindset and view decisions through this lens.
- Align Plan and Participant Interests. The Advocate’s role extends beyond compliance and empathy. By adopting a Participant Interest Mindset, they can align the interests of the plan and its participants, leading to better benefits, lower costs, and increased employee satisfaction.
Remember: In today’s complex healthcare landscape, Advocate Advisers guide organizations to align participant interests with plan sustainability.
Don’t Miss Our Webinar
Join us on January 15th at 11:00 am CT for “Why Employees Are Suing Employers Over Health Benefits.” Hear from Ann Lewandowski as she provides valuable perspectives on employees’ legal challenges and the broader implications for employers navigating these complex issues.
Space is limited so register today.
