Healthcare cost projections running in the high single-digit to low double-digit range on a blended medical and pharmacy average are "just not sustainable" for employers or their employees, says Brooks Deibele, SVP of Employee Benefits at Holmes Murphy, one of the largest independent privately-held brokerages in the country, headquartered in Des Moines.
Deibele joined Holmes Murphy's Minneapolis, Minnesota office in July 2019 after roughly 16 years on the carrier side, first at UnitedHealthcare, where he spent about a decade in individual contributor and leadership roles, then at Blue Cross Blue Shield of Minnesota, where he led the commercial group business and served on the executive team.
Today he oversees employee benefits nationally for the 100%-employee-owned firm, giving him a vantage point across the industry and some of the key challenges it faces today.
In a conversation with Insurance Business Benefits US, Deibele addressed the escalating cost of healthcare that employers (and their brokers) are trying to manage without shifting the burden onto workers.
"I wish I could tell you there's a silver bullet," he said. "There isn't. Each client situation is different in terms of their willingness to embrace some level of disruption, change management, to ultimately control costs."
Holmes Murphy's approach starts with procurement discipline: ensuring clients have best-in-class contracts with every vendor they partner with, reviewed on a regular schedule.
From there, the work turns to claims data - understanding what is actually driving costs before selecting interventions. Direct primary care is a consistent priority, as are tiered networks that steer employees toward higher-quality, more efficient providers.
"The status quo is going to get you a 10-plus percent trend increase from one year to the next," Deibele said. "In most cases, it's going to be a series of several levers that gets them to where they ultimately want to be. You've got to be looking at multiple things on a continuous basis and putting together a multi-year roadmap."
That roadmap philosophy extends to how Holmes Murphy advises clients to think about renewal planning. Shopping coverage annually, Deibele noted, is not a viable long-term strategy, particularly when carriers are not currently competing aggressively on price. "We're not seeing carriers in this environment willing to buy business," he said. "A multi-year strategy is critical."
The firm's position on plan design is equally unambiguous. "For most employers, the easy button is no longer palatable," Deibele said. "You can't just take an integrated solution from a third-party administrator and set it and forget it."
Deibele advises close partnership between brokers and plan sponsors, sustained over years, with an appetite to challenge vendors and push back where needed.
"I view it as a call to brokers and employers to partner closely over the next several years to tackle healthcare costs aggressively, to push back on the industry, on vendors where needed, to accomplish the goal of flattening and reducing healthcare and benefit costs."
Pharmacy benefit trend is the number Deibele watches most closely and with good reason. He described pharmacy costs as running in the double-digit range, pulling up the blended medical-and-pharmacy trend figure that employers are seeing in projections for the coming year.
Holmes Murphy has a dedicated pharmacy consulting practice, led by Nathan Casson, that is engaged consistently across the firm's client base. The practice focuses on ensuring clients have the right pharmacy benefit manager (PBM) partner, the right contract, the right formulary, and a network oriented toward lowest total net cost.
"We have several scenarios where we've done creative things around specialty drugs, around formularies with non-traditional vendors outside the big three that have really helped our clients manage their costs," Deibele said. "In some of these cases, there is going to be disruption - change management in terms of where and how people access their drugs. But it can come with significant savings."
The variability in healthcare pricing across providers with comparable outcomes is what frustrates him most. "Going to provider A versus provider B with similar outcomes, but one of them is three times the cost of the other - how do we get people to the more efficient provider?" That same logic, he said, applies equally to drug procurement.
On plan structure, Deibele confirmed a clear market shift away from fully insured arrangements toward level-funded, self-funded, and captive options - with smaller employers increasingly exploring them, while individual coverage health reimbursement arrangements (ICHRAs), rebranded as "CHOICE," have not grown as anticipated.
"That's by and large because it's really an employer cost-savings mechanism - you're capping the exposure," he said. "It's not leading to reduced costs across the system. And if you just look at the broader trend in the individual market space, it's not good - it's worse than the group space."
As plan changes grow more complex, Deibele argues that the broker-client relationship itself becomes a competitive asset. Recommending significant departures from arrangements that have been in place for years requires something that cannot be manufactured at renewal time.
"Trust and transparency over the course of the relationship, being proactive - the worst thing you can do is prepare somebody too late for what's to come the following year," he said. "You're behind the 8-ball."
Holmes Murphy has been preparing its clients well in advance of what Deibele expects to be a difficult renewal year. "We've been signaling to our clients for quite some time that next year is going to be a challenging year from a cost trend perspective," he said, "if they're not actively looking at where and how they can make changes to mitigate that trend."
Looking out four to five years, Deibele sees artificial intelligence as broadly positive for the brokerage profession; not a threat, but a tool for freeing advisors to do higher-value work.
"I view it as a huge advantage in freeing our people up to spend more time with our clients, to strategize and work at the top of their job description and ultimately produce better outcomes," he said.
He cited contract analysis, quoting, and administrative spreadsheeting as areas where AI-driven efficiencies could have meaningful impact. Holmes Murphy has invested in digital transformation to provide its team with modernized workflows.
"Anytime you're faced with challenges, naturally you see innovation that follows," he said, pointing to new models in care delivery and benefits access that are putting better information in employees' hands faster. "That's the thing that excites me the most - the innovation coming through startups and through established players who are expanding into other areas."
