Lunch & Learn: The Power of Transparency in Employer Health Plans

At PFG MedComm, we are constantly looking for opportunities to expand our understanding of the ever-evolving healthcare landscape. That’s why we were thrilled to welcome Chelsea Ryckis, Founder & President of Ethos Benefits, for a recent Lunch and Learn session that left us not only informed but inspired. Since founding Ethos Benefits in 2017, Chelsea has been a trailblazer in designing fiduciary-based health plans that prioritize transparency, cost savings, and employee engagement. During our session, she shared her expertise and passion for improving the American healthcare system, focusing on employer-sponsored healthcare, pharmacy benefit managers (PBMs), and innovative solutions for reducing costs and improving outcomes.

Chelsea’s journey into healthcare advocacy is as compelling as her expertise. Originally from Canada, she was drawn into the complexities of the U.S. healthcare system after a personal encounter with medical debt stemming from a sports injury during her college years. Her story of resilience and her mission to challenge the inefficiencies and misaligned incentives within the healthcare system set the stage for a thought-provoking discussion.

Here are a few key takeaways from her session:

1. The Impact of Employer Decisions on Healthcare Access: Chelsea underscored that over 181 million Americans rely on employer-sponsored health plans, with employers making decisions that directly affect their employees’ access to quality care. The magnitude of these decisions often goes underappreciated, despite their critical role in shaping employees’ well-being.

3. The Challenges of the Current Healthcare System: Chelsea explained how traditional healthcare models, particularly those dominated by the "BUCA" carriers (Blue Cross, United, Cigna, and Aetna), are riddled with inefficiencies. Misaligned incentives across PBMs and brokers lead to higher costs for employers and employees alike. Real-life examples, such as negotiating down exorbitant hospital charges or uncovering unnecessary markups, illustrated just how pervasive this issue is.

4. Innovative Solutions for Employers: Through her work, Chelsea and her team have designed custom healthcare plans that emphasize transparency, fiduciary responsibility, and data-driven decision-making. These models have led to significant savings—often reducing healthcare costs by 30–40%—while improving the quality of care. Her insights into fiduciary PBMs, stop-loss insurance, and the benefits of unbundling healthcare plans offered a fresh perspective on how employers can  control over their healthcare spending.

5. The Rise of Lawsuits and the Importance of Fiduciary Responsibility: Chelsea also shed light on the growing trend of health plan lawsuits against employers who fail to act as fiduciaries of their employees' healthcare dollars. This serves as a stark reminder of the importance of working with advisors who prioritize fiduciary practices and transparency.

6. Emerging Trends in Employer Priorities: Employers are increasingly focusing on wellness initiatives, mental health resources, and family-oriented benefits such as fertility support and adoption assistance. However, Chelsea highlighted the need for data-driven strategies to ensure these programs deliver meaningful results.

"A lot of employers don't realize how profound and the magnitude of the decisions that they make every single year, which is millions of people's access to their number one asset— their health."

The discussion also touched on parallels between employer-sponsored healthcare and pharmaceutical market access, particularly in understanding the needs and priorities of payers. Chelsea’s insights provided valuable context for the work we do at PFG MedComm, helping us think more strategically about payer engagement.

We extend our heartfelt thanks to Chelsea for taking the time to share her knowledge and experiences with us. Her expertise and passion for transforming the healthcare system remind us of the importance of innovation and advocacy in this space. We look forward to applying these learnings in our own work and exploring new opportunities to drive better outcomes for clients and stakeholders alike.

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