Enabling Better Benefits Decisions

by Julia Lynam

A Williston company is helping to revolutionize the healthcare insurance system in this country. Enabler Corp., established by former Fanny Allen Hospital president Gary Morel in 1995, is finding new ways to navigate the minefield of insurance options in partnership with healthcare providers and businesses.

“We work with two types of clients,” Morel explains. “We help healthcare providers evolve their own managed care plans, and we help businesses save money and improve employee health through choosing, or setting up, the right benefit program.”

Gary Morel

Gary Morel, former president of Fanny Allen Hospital, helps healthcare providers and businesses choose from several hundred health insurance options. (Photo: Jeff Clarke)

Different strategies are appropriate for different employers. “We do the market research on insurance products available from the different insurance companies,” Morel says. “In Vermont, small businesses are faced with a choice of up to 700 different insurance options from about 12 different companies and 50 trade associations that can offer plans to members. Most companies are paying too much for their benefits,” he continues.

A graduate of the University of New Hampshire and the University of Minnesota master’s of hospital administration program, Morel, 42, became president of a children’s orthopedic hospital in Portland, Ore., straight out of college. “I was there for five years,” he says. “Then, at the age of 30, I came to Vermont as president of Fanny Allen Hospital in Colchester, which was at that time an independent, Catholic, community teaching hospital.

“I was the first lay administrator of Fanny Allen, and I was brought in when the hospital was dying financially and was merging with the larger Mary Fletcher Hospital in Burlington. I was the turnaround executive. I introduced the two boards and got them talking. It was a fantastic job and I loved it.”

That job done, in 1991 Morel moved to Monroe, La., to help set up the North Louisiana Healthcare Alliance, a coalition of 26 hospitals, the regional medical society and 45 businesses.

“The biggest hospital was being boycotted by providers for having introduced managed care,” he recalls. “The Justice Department was involved with an anti-trust action — this was a problem that I had to solve.

“As the equivalent of a mediator, my job was to get the various factions to the table and ask who was responsible for the situation. They started pointing fingers at each other, then they realized that they all had a part in creating the problem and therefore they all had a part to play in solving it.

“Together we resolved the differences and designed a new community managed care plan. We set up two healthcare management organizations (HMOs), so that the hospitals got an HMO that they controlled, the physicians got an HMO that they controlled, and the businesses got health planning and tax relief.

“We affiliated with groups throughout the nation that were interested in the role of business in controlling healthcare costs.

“All this was happening at the time that President Clinton was talking about re- engineering health care in the nation, and we were a prototype model for what it could be.” Ruefully he recalls the defeat of the president’s healthcare reform initiatives.

By the time he’d sorted out the Monroe situation, Morel and his wife, Sharon, whom he’d met at graduate college, had three children and were interested in settling down. “An occupational hazard of being a hospital president, which you don’t know about until you’re in it, is that it’s basically a field of gypsies,” he comments. “The average tenure of a hospital CEO is three years. And that’s fine until you have children who need stability and continuity.

“So, when I was no longer needed in Louisiana I asked two questions: First, I asked my wife where she would want to live forever. And, secondly, I asked the board of directors of the North Louisiana Healthcare Alliance if we were done and if I could buy the company.”

The answers being “Vermont” and “yes,” the Morels returned to settle in Williston with Meghan, 13; Lindsey, 11; and Brent, 9. Gary sits on the school board and coaches teams for the national, problem-solving children’s challenge, The Odyssey of the Mind. “The Williston teams came in second in the state last year,” he says. “This year we’re planning on making it to the nationals!”

He renamed the company the Enabler Managed Care Corp. and set up an office in Williston, three miles from his home. Morel originally intended to work mainly with large companies throughout the country, helping them to set up their own healthcare insurance plans and eliminating the need for an outside company to provide insurance. Enabler’s role, once such a plan is established, is to administer it, offering credentialling, pricing, claims adjudication, provider contracting, reinsurance, marketing and wellness programming. For this Morel uses his core staff of five in Vermont and on-site sub-contractors.

He had not anticipated, however, the number of provider organizations that would be interested in offering their own healthcare plans. “Originally I thought that the work with companies would make up about 95 percent of Enabler’s revenue,” Morel says, “but in the first year we ended up with 80 percent of our revenue from healthcare providers setting up their own programs.

“If a hospital comes to us as a client,” he explains, “we first help them to stop buying healthcare insurance and evolve a self-insurance plan for their own employees.” This involves a move to demand side management, working with employees to keep them healthy, rather than supply side management with its emphasis on utilization reviews.

“I reckon if local hospitals and physicians can’t figure out how to take care of the health of their staff no one can,” Morel continues. “We need to re-engineer and change the incentives to get doctors away from the idea that the more they do the better they get paid, to the more they keep us healthy the better they get paid.”

Sharon Parent

Enabler Managed Care Corp. has doubled or tripled its business each year since its 1995 inception. It serves increasing demand in New Hampshire from a satellite office in Claremont. Pictured: Sharon Parent, claims adjudicator (Photo: Jeff Clarke)

The second step is for the hospital to move to sponsoring healthcare insurance for the community. “Community hospitals in the 1800s were set up to service the health needs of the local community,” Morel says. “A hundred years later we’ve got away from servicing health and we are focusing on servicing sickness. The doctors are the experts; let them help the rest of the community manage their health. We need to re-engineer the financial incentives, and pay the people with the most experience to change their orientation and put it to good use for the community.

“This is happening in pockets all over the country, but not yet in Vermont,” he says, adding with a wry grin: “This is a great place to live, but the work is elsewhere!”

Mississippi Health Partners in Jackson, Miss., is an example of a provider hospital organization. “Gary Morel acts as a consultant to this organization,” says president Sandra Burns. “We’ve been business associates for almost 10 years. He was executive director of the Monroe, La., Business Coalition when I was director of the parallel organization in Atlanta, Ga., and we both served on the board of the National Coalition on Health.” Burns explains that the model of a provider organization offering a managed health plan not owned by one of the big insurance companies is becoming common in many parts of the country.

“I’d like to see provider-sponsored health plans happening everywhere,” Morel says, “and we at Enabler have the skills, knowledge, research and contacts to make it happen.”

The third part of the Enabler operation, now making up about half of its business, is in helping smaller companies identify or create the most cost-effective plan for their particular circumstances. About 50 of these clients are in Vermont, making up 20 percent of Enabler’s business.

“This was not something I set out to do,” Morel says, “but some former Fanny Allen board members asked me to help them find the right health insurance for their own companies and this led to us putting together a comprehensive database for Vermont and offering this service for small and medium sized companies.”

One of those former board members was John Powell, president of Flanders Building Supply of Essex Junction. “When I was chairman of the board of Fanny Allen I found Gary to be someone who could handle complex facts with amazing skill,” says Powell. “I felt he’d do really well in the entrepreneurial world and I encouraged him to think of going into the business world outside the medical field.”

Flanders, staff numbers varying seasonally from 25 to 35, has, after consulting Enabler, opted for a plan offered by MVP. “The insurance business is still complicated enough that I would look to someone I trusted to recommend the outcome of a search,” Powell says. “When you’re dealing with insurance all you have is a promise of something that will happen in the future, and a person with wide experience can tell you what you might expect with a particular insurance company.”

Another option open to larger businesses is self-insurance, a path taken by more than half of all employee health plans nationwide, according to Morel. “All the biggest companies are self-insured,” he comments. “So the HMO phenomenon is really targeted towards smaller employers and the price of the premium is one of the driving factors in the market.”

Under Vermont law the minimum size for self-insurance is 50 employees; in New Hampshire it’s 100. Companies with fewer than 50 employees can adopt a “minimum premium” strategy, he says, where they buy the smallest amount of insurance required by the state, with a very high deductible, and self-insure in addition to this.

Trans-Border Customs Services of Champlain, N.Y., is one of those that have switched to self-insurance, with Enabler as administrator. “We previously had four different plans,” says Barbara Boyer, human resources coordinator of Trans-Border, which has more than 190 employees at locations in four states. “Rates were getting very high, with substantial increases every year, so we decided to look at self-insurance. Enabler helped to make it easy and everyone has benefited — employers and employees. We took the best of the HMOs and the best of indemnity plans and put them together to come up with something that was better than before at a much more affordable rate.”

It’s important to take care with health plans, Boyer says, “because people are very sensitive about it. They want to be able to see the doctor they choose and not have to worry about large deductibles.”

Since Enabler started in 1995, business has doubled or tripled each year, and Morel sees this growth continuing. New Hampshire is a major growth area for the company and he has added a second small office in Claremont to accommodate that situation.

Faced with such rapid growth, Morel’s biggest problem is one familiar to many Vermont employers: finding the right staff. His core staff of five are specialists in claims adjudication, marketing and customer service, but Morel is seeking three more team members. “There’s a unique skill-set we can bring to an employer,” he says, “and it’s difficult to find the right people.”

Despite that challenge, Morel’s move into business ownership has brought him the stability he sought to enjoy family life. It’s also provided fertile ground for him to put his unique skill-set and experience to good use.