Podcast Summary: School Business Insider

Episode: The State of School Employee Healthcare: Costs, Culture & the Road Ahead
Date: December 16, 2025
Host: John Brucato
Guests: Eric Gilbert (Managing Director, Daybright Financial), Adam Henson (Director of Financial Analytics & Underwriting)

Episode Overview

In this episode, host John Brucato sits down with Eric Gilbert and Adam Henson—two leading benefits consultants—to discuss the profoundly challenging landscape of school district employee healthcare. From surging costs and generational shifts in employee expectations to questions around data, plan design, and innovation, the conversation offers a comprehensive look at the current and future state of school employee benefits. The discussion is both data-driven and practical, sharing hard truths and actionable advice for school business officials (SBOs) looking to balance competitive benefits with fiscal responsibility.

Key Discussion Points and Insights

1. The Current State of School District Healthcare Costs

Timestamps: 02:02–03:54

• Healthcare costs are rising sharply, often outpacing expectations.
• "We're seeing 8 to 10% increases in average medical trend. But... we've seen increases in the 30 and 40% numbers, which is really challenging from a taxpayer standpoint in schools..."
  — Eric Gilbert [02:20]
• Cost pressures are exacerbated by:
  • Surging demand for new drugs (especially GLP1s, such as weight-loss and diabetes medications)
  • An aging workforce, with baby boomers retiring and straining the system
  • Nationwide doctor shortages and increasing healthcare utilization

2. Generational Shifts and Their Impact on Benefits Design

Timestamps: 03:54–09:53

• Baby Boomers are now outnumbered by Gen Z and millennials in the education workforce, which impacts benefit expectations.
• Gen Z and millennials value holistic, flexible benefits—not just strong medical coverage.
  • "They're looking for balance in every direction... They want more parental time off, they want different types of benefits offered, including things like pet insurance."
    — Eric Gilbert [05:35]
  • Importance of lifestyle accounts and ancillary benefits (gym memberships, elder care, childcare, financial planning, etc.)
• Gen Z's health literacy is low: "Less than one in four understand the three terms: deductible, coinsurance, co-pay."
  — Adam Henson [08:17]
• Communication and education around benefits must adapt—one size no longer fits all.

3. Where Are the Costs?

Timestamps: 09:53–12:11

• Prescription drug costs, especially GLP1s, are driving up spending.
• Chronic disease management is crucial—1% of members can account for up to 24% of plan spend; the top 5% make up half.
  • "If you're not attacking diabetes, high blood pressure, cholesterol... then you're not really impacting or moving the needle at all."
    — Adam Henson [11:20]
• Lack of granular data is a major obstacle. Without it, districts can't effectively understand or attack the real cost drivers.

4. Telemedicine and Wellness Programs

Timestamps: 13:28–15:49

• Telemedicine and MSK (musculoskeletal) programs help, but mainly control small claims—not the large, chronic disease costs.
• Generational differences again: younger employees engage more with digital health tools, while older generations prefer traditional care pathways.
• Communication preferences also differ: booklets for Boomers, apps for Gen Z.

5. Changing Employee Expectations & Recruiting

Timestamps: 15:49–19:25

• Standard benefits (medical, dental, vision) are now table stakes.
• Increasing demand for behavioral health, mental health support, greater plan flexibility, and soft benefits (like childcare/elder care).
• School districts must move beyond "single or family plan" paradigms and offer more granular, customizable options, especially with high-deductible health plans (HDHPs) and Health Savings Accounts (HSAs).
  • "Health savings accounts are unbelievable. They're triple tax advantaged... those are strategies that we're talking through with districts that are really trying to break their current paradigm of these copay platinum level plans."
    — Eric Gilbert [18:10]

6. Collective Bargaining, Data Transparency, and Practical Barriers

Timestamps: 19:25–22:49

• Plan innovation is often constrained by union agreements and lack of flexibility in labor contracts.
• Without data transparency, districts cannot meaningfully change or modernize their plans.
• Employers must carefully structure contributions to avoid making high-deductible plans and copay plans equally expensive for employees, which defeats the purpose of offering choice.

7. Doctor Shortages & The Changing Healthcare Market

Timestamps: 21:51–26:06

• The looming doctor shortage is as significant as shortages in teaching and other professions.
• On-site clinics, direct primary care, and concierge medicine may become key differentiators in recruiting and retaining talent.
• Millennials and Gen Z frequently lack primary care relationships and may lean on urgent care—potentially less optimal for long-term health.

8. Advancements in Medicine—Cost Saver or Driver?

Timestamps: 26:37–30:45

• Advances in technology, AI, and new pharmaceuticals bring both promise and challenge:
  • In the short term, they are often cost drivers due to overutilization and high price points.
  • "There's not a lot of money in pharmaceuticals curing diseases... They make money by selling prescriptions and they need you on those prescriptions."
    — Adam Henson [27:22]
• Real-world cost savings from new drugs (e.g., GLP1s) are yet unproven or are limited to continuous use and significant lifestyle changes.

9. Strategic Benefit Design for Recruitment & Retention

Timestamps: 31:11–36:15

• SBOs should build attractive designs for the low-cost majority of employees to help recruitment, while not encouraging "super-users" of healthcare (who are very costly) to enroll disproportionately.
  • "I want to build a plan design that is so overwhelmingly attractive to that bottom 50% that costs me nothing... And on the other side, that 1%, that's very, very high cost, I want to make sure that my plan is not having them hyper-select my plan..."
    — Adam Henson [31:32]
• Data-driven underwriting and analysis are critical, but only if data is made actionable and linked with expert insight.

10. Innovations & Practical Approaches

Timestamps: 36:28–41:21

• Some districts are innovating with consortia, self-insurance, or layered risk pools—but success depends on the ability and willingness to intervene in healthcare usage.
• Modernization in the private sector is ahead of public institutions; public sector districts can borrow HDHP, HSA, and voluntary benefits models for cost management and improved flexibility.
• Communication and education are linchpins—innovative benefits fail without strong, clear employee communication.
  • "You could have the best idea in the world, but not being able to execute it in your future workforce... that'll be the unfortunate piece of not communicated well."
    — Eric Gilbert [41:15]

11. Why is Healthcare So Confusing?

Timestamps: 41:21–46:35

• Core reasons: opaque pricing, complexity, overwhelming documentation, lack of usage leading to misunderstanding, and few people know how the system works unless they're forced to by circumstance.
  • "Most just shut down and don't bother learning it unless they are in the system because they are unhealthy, because they have to learn it."
    — Adam Henson [41:40]
• Effective navigation and advocacy/concierge support are critical—especially in high-touch events (childbirth, major illness).

12. Final Advice for SBOs

Timestamps: 46:47–48:37

• "Flexibility, flexibility, flexibility. If you are prescribed into the exact deductible, carrier, and out of pocket... you've got no levers to impact or change anything."
  — Adam Henson [46:47]
• Data transparency is essential: "They are owing taxpayers answers to why health insurance goes up at double digits every year... Data transparency has got to be a big topic of conversation."
  — Eric Gilbert [47:21]
• Education, communication, and advocacy can make or break any new benefit initiative.

Notable Quotes & Memorable Moments

• "It's not just New York that's kind of feeling a lot of pressure right now... All of the baby boomers will be over the age of 65 [by 2030]. That is a huge strain on the entire medical market, insurance, hospitals, everything." — Adam Henson [02:54]
• "Gen Z's come to work with a balanced brain and they're looking for balanced benefits... not just co-pays and medical insurance." — Eric Gilbert [05:40]
• "Chronic disease. Chronic disease. Chronic disease. When you talk about your health care spend, 1% of the population accounts for 24% of your plan spend." — Adam Henson [11:09]
• "If you don't use [health insurance], you lose it, from an understanding standpoint." — Eric Gilbert [43:02]
• "We've been talking about shortages in teachers, bus drivers, business officials. Now doctors. What's everybody doing?" — John Brucato [22:49]
• "The only people that know how the system works are the ones that are navigating it every day." — Adam Henson [41:40]

Important Timestamps

• 02:02 – State of current healthcare costs
• 05:02 – Gen Z expectations & generational transitions
• 09:53 – Cost drivers (GLP1s and chronic disease)
• 13:28 – Telemedicine and generational use patterns
• 18:10 – High deductible plans and HSAs
• 21:51 – Doctor shortages and direct care clinics
• 26:37 – Technology as cost saver vs. driver
• 31:11 – Strategic plan design for recruitment/retention
• 36:28 – Stop-loss, lasers, and new forms of risk management
• 41:21 – Why benefits are so confusing
• 46:47 – Final words of advice for SBOs

Tone & Conclusion

The episode is candid and practical, seasoned with humor and real-world anecdotes. Guests urge school business officials to be flexible, data-driven, transparent, and relentless in educating both themselves and their employees. Innovation is needed, but success will depend on good communication and the willingness to rethink longstanding benefit conventions in light of changing workforce needs and surging costs.