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26 Jun 2025 · 14:51 The Peel Inside the $2 Trillion Employee Benefits Market | Ryan Sachtjen, Threeflow

“Like they put so much data science and and research into this and it's like you spent a dollar to just win an ad. And then and then this on the other side, it's like, you know, Walmart or, you know, a Fortune 5 company buys an insurance policy that they pay $50 million for and it's just some emails back and forth, just and and that that's the thing where we I think our our point of view in understanding the business was was helpful because there is a lot that goes into that and there's a lot of nuance that needs to be true that you have to be able to deliver in order to help that problem.”

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belief
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26 Jun 2025 · 14:51
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The Peel

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…kes it even harder to just kind of skip and go direct to the company when they're like they need different products. They need different expertise in different places depending on what they need. Yep. There's there's an expertise element to it. And there's just a simplicity of how do we make it easier in we give you a method to be able to work. We have one operating system that allows for you to work with a bunch of the supply side carriers as a broker. And I think what we observed was there was an interest for if you think about the employee benefit broker today, it's a professional services company typically a relatively small organization and they they want and need a technology stack that works for them. But historically that has not been the case. They've used older legacy software systems that haven't been of high value. And so what they've typically done is built their own workstreams that are largely based in Microsoft products and workflow documents and things like that. What are the software tools? Is there like some kind of a database thing that was made in the 80s or the 90s that they use? Is that the stack we're talking? Yeah, it is. I mean it is. There's there there's a agency management system stack which are pretty old legacy systems that they will typically use as their back office for organizations of clients policies and then compensation for their producers and also just some basic information about their customers. But it is it is limited on its functionality for sure. And so there has been this thirst for how do I find something that allows for me to operate my business better and more efficient and effective, but there hasn't been a huge tech stack that has been available for this segment of the industry, especially one that is as large as it is in terms of just like dollars transacted. Yeah. What's like the I don't know market size TAM if I'm if I'm you know using the the VC lingo on I mean you know the the rough estimate each year is in this in the health care spend space you know it's well over two trillion a year and if you break that down further into like when you pull out Medicaid Medicare and you just include the like employer sponsored you're still at like well over you know 1.5 to$1.8 8 trillion that is transacted across all of the premium across all of the employers across the country. And so it's massive, right? And it's it's controlled through this distribution network that's actually fairly small if you think about the number of individuals that are employee benefit brokers, employee benefit carriers. Yeah. and was always a bit of the joke when I was on the wholesale side in talking to friends that were in other areas of trading finance explaining like this is how this transaction works where I'm emailing things back and forth 25 times and it's a multi-million dollar like opportunity from a premium standpoint and this is the way that it comes together and it usually would make people snicker of like that can't possibly be the way that it works and it's it's very true it's very true yeah well you think of like like Facebook or Google ads you can spend a dollar on Facebook and it's like the most ke that can't possibly be the way that it works and it's it's very true it's very true yeah well you think of like like Facebook or Google ads you can spend a dollar on Facebook and it's like the most automated machine-learned like possible thing on earth. Like they put so much data science and and research into this and it's like you spent a dollar to just win an ad. And then and then this on the other side, it's like, you know, Walmart or, you know, a Fortune 5 company buys an insurance policy that they pay $50 million for and it's just some emails back and forth, just and and that that's the thing where we I think our our point of view in understanding the business was was helpful because there is a lot that goes into that and there's a lot of nuance that needs to be true that you have to be able to deliver in order to help that problem. It's very easy, I think, to say unilaterally it's this is obviously something that we can improve and make more digital. Uh but then when you like actually double click into it, there's a lot there. What's like sort of the take rate then on different levels of it? Like when a broker sells a policy to a employer and then like what does the carrier get and kind of I don't know profit or cut take rate throughout kind of like the value chain. How does it work? Yeah, I mean if you think about from a carrier perspective, you know, when they think about a dollar of premium, y they then break that down into, you know, what is the claim cost of that? And so there are certain products that are high incident, low severity, meaning like you're going to use it a lot. Medical is actually one of those where you're using you're using a fully insured medical product. And so there's a bunch of claims that are happening every single day. And then there are some products that are like high severity but low incidence meaning it doesn't happen that often but when it does it's big be like hurricane or fire damage or even a life insurance right you've got you've got a company and it's 200 employees the the frequency to which that will be a life insurance claim. It's like one or two per thousand is sort of like the number. And so the way that they think about it is they cut down that dollar of premium to what's the claim cost and then what is the expense layer of that. And for a lot of the insurance companies, the majority is claim cost. And then when they think about the acquisition cost for their team, like for someone to sell a product into a broker, then ultimately into a player, you know, probably 8 to 10% of premium. Isn't that their distribution cost? And then the remainder is sort of running the operations of their business and the distribution cost of paying like a broker as well. And so historically brokers get compensated as a percentage of premium but we you have seen a bit of an evolution on that where some brokers are using more of a feebased structure. And so it's a little split. I would say generally larger employers if you're a broker that works with larger employers you've got more of a feebased structure. And if it's smaller, you typically have more of a percentage of premium. But say generally larger employers if you're a broker that works with larger employers you've got more of a feebased structure. And if it's smaller, you typically have more of a percentage of premium. But that's typically the composition of how does every like where does the cuts of the dollars go? You know, when $1 of premium is sold. And you know, the goal for the insurance companies are of course grow the top line as much as you can, sell as much premium as you can, retain it at the highest level possible, the lowest payouts, the lowest claims and the lowest, right? And do it at the like at the least claim cost bit. And that's where you obviously see friction and rubbing like that as a fundamental element of the economics of the business and then how that intersects with the human element of the business where you know people obviously have a point of view on you know what should go into claim decisions whether it's fully in medical or others but economically that's the big driver of I want to grow I want to persist and I want to do so at a loss ratio that is as low as possible and that's those those are the three tenants that all insurance companies operate by. Are there any regulations around or laws around like they need to have certain ratios from like a security of the industry or safety of the like making sure that you're you can't profit more than this or like aren't there caps or something? Am I Yeah, there okay in some segments. So part of the affordable care act introduced this idea of a minimum loss ratio which was for the medical insurance product. Okay. And so basically what it says is if if you run at a certain loss ratio or better as an employer, you are you get a dividend back. So you get money back into you can either roll into next year's premium or you get that dollar back. Yeah. So that minimum loss ratio threshold was pretty new to the industry and it right now persists really in that fully insured medical segment as like the area where there is a regulatory element and constraints to how can you run this in a way where it's profitable but not too profitable and it gets to the point where then you share that back with the customer. Interesting. Yeah. Do and how newish is that? Is this like a fivey year 10 year thing or? Yeah, I mean it we're you know we're within the first decade of this coming through and so you know I think depending on the product this it is a very competitive marketplace when you think about you know medical insurance products or the non-medical in particular the ancillary market life insurance dental insurance vision insurance um these carriers are running like a lot of times they're baking in a two to 3% profit assumption on their book uh it's just Their volume is so high. They've got a $3 billion book, $4 billion book. So, they spin off a nice a nice eB profit off of that. But the dynamics of it being a very very competitive marketplace definitely compress the ability to earn a ton of profit because if you do too much, you'll get exposed and then you'll have a you'll have a retention problem. And if you go to What does that mean? A retention problem? meeting you will…

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