Last spring, when the trickle of health care reform questions from clients turned into a flow of Web casts and weekly newsletters, Mike Brewer, president of Lockton Benefit Group, knew it was time to create a formal practice devoted to the ever-changing legislative landscape of Washington. He spoke with EBA about his leading brokerage's newly formed Health Reform Advisory Practice.

How did this Advisory Practice come about?

Because of the business we're in and the nature of this company, we're pretty heavily engaged in the health reform discussion anyway, both at the national and local levels with our carrier partners. So we had become a repository of information regarding what was going on.

I have two of the top compliance attorneys working every day on this, so we had become pretty knowledgeable about what is going on in Washington, even though the situation is pretty fluid there. Then clients began asking 'What is this going to mean for us, and what kind of information can you provide?' So we started doing weekly health reform briefs that we send to clients and prospects and our own associates.

We've done a couple of health care reform Web casts led by our two health care reform attorneys. It became a pretty natural transition for us to formalize that practice.

What does the practice consist of?

Of course, the reality is we don't know exactly what that legislation is going to look like when it rolls out, but we've made some presumptions. Compliance is going to be a significant part of it, and we're fully staffed to do that. There could be some tricky actuarial requirements with minimum plan values and "pay or play." There are some minimum plan standards that are at least being discussed.

We are encouraged to see that there seems to be mounting support for strengthening our ability to affect wellness programs with employers. So we've got our two medical directors as part of that team.

Certainly data analytics are going to be important; regardless of what comes out of this, there's going to be a certain amount of information that's going to have to be generated. We're positioned to do that.

And we know there are going to be huge communication issues, so we've made communication part of the practice as well. We're getting calls every day about this.

Have you had to make any adjustments with the structure of the company, or does the Advisory Practice already fit in with your business plan?

A little bit of both. We've had the people on staff to provide those services.

We really formalized the practice to put a fence around what we were trying to do with regard to health reform and also to provide some assurance to our clients and prospective clients that we're on this - that we've devoted some time and energy to getting knowledgeable about what this is going to mean for them.

We have pretty regular meetings. All of these folks have other duties, obviously, but this is a pretty important priority, so we make time to make sure that we're advancing the cause.

We'll probably have to add staff once we have a clearer picture of what the requirements are going to be. We're certainly prepared to do that.

What's been the benefit of the practice to Lockton and to your clients?

[Being] an information source. It's increased our visibility. We wanted our clients to be comfortable that we had a handle on this - that we were as knowledgeable as possible about where things sit on a day-by-day basis.

It's certainly benefited us. It's allowed us to stay forward-looking and focused on it [more than] if we were just watching from the sidelines. Now that we've got folks who have a responsibility to help our clients stay informed it's helped our internal focus. That's been helpful to our clients.

How often are you getting questions and what are people asking?

We've got several people fielding calls. Our producers get asked questions all the time that find their way back to us. A lot of the questions have been, "Where do you think it sits?" "What do you think the outcome is going to be?" "What would this provision mean to me?"

Again, it's all pretty speculative because there's nothing set in stone yet. We think we have a fair sense of where it's headed, but that could change tomorrow.

How do you deal with that uncertainty, which can make some people indecisive?

Well, indecisive is not our nature. The first thing we did was make sure that we had our information resources boxed pretty well and that we were on top of the information. Then we populated the practice with existing staff members who have to be knowledgeable about this anyway.

[Also] we made sure that we had contingencies, because when it does come, you know there's going to be increased complexity and increased work for us to do, and we'll likely have to add additional resources in order to accommodate that.

Do you see the practice continuing through the foreseeable future?

I absolutely do. I suspect this is going to be an important part of what we do for the next several years. That's contingent upon the nature and the complexity of the legislation that emerges out of all of this.

There's going to be some reform, and frankly there's a lot that we're very much in favor of and that we think is appropriate. We're all for good reform, we just struggle with bad legislation sometimes.

When you're helping people, does your opinion come into it?

I think as a general rule, they're pretty interested in our opinion. They expect that we're going to be better in formed than they are and certainly they're interested in our opinion.

I don't think anybody is against health care for everybody, it's just a question of how you go about doing it.

Is there anything about the proposals that particularly concerns you?

Certainly. The public option is a concern to us. It's difficult to envision how a public option won't disrupt the existing private insurance system. We like the fact that there's not a national public option [in the Baucus bill]. The co-ops and some of the things that are being discussed we think could be manageable. We think it could be beneficial. That concerns us a whole lot less than a full-blown Medicare-like public option. There are a lot of other things we like.

What are you hoping gets passed?

An overhaul of Medicare, just trying to eliminate the fraud and abuse in Medicare would be a huge step forward. The insurance company side has agreed already to discontinue underwriting based on pre-existing conditions. That's a step in the right direction. And we think there are people out there who need help paying insurance premiums, and it's the right thing to do to subsidize those folks.

As things emerge and policies get put in place, then we'll come out with, "Here are three things that you need to do today." That's the nub.

We need to be able to provide answers when a client says, "What do I need to do?" EBA