In this episode of The Business of Benefits, Donovan Ryckis sits down with attorney and national thought leader Alden J. Bianchi to expose one of the most costly and overlooked failures in employer-sponsored healthcare: the illusion of broker transparency. The Consolidated Appropriations Act (CAA) was supposed to fix hidden compensation. It didn’t. Instead, it created a fiduciary requirement to ask, without ever creating a requirement for brokers to actually tell. Employers are expected to manage fiduciary risk without pricing transparency, claims clarity, or conflict-free advice. Alden brings decades of experience advising Fortune 500 employers, consulting firms, and government agencies on ERISA, fiduciary duty, ACA compliance, transparency regulation, machine-readable files, and emerging litigation.
In this conversation, he explains why:
- CAA compensation disclosures are “an absolute joke”
- Brokers and ASOs avoid disclosure by redefining themselves
- Employers are left negotiating blindfolded
- Current PBM and ASO lawsuits are stalled by standing issues
- Fiduciary governance needs to mirror 401(k) standards
- Machine-readable files and AI will change everything
- Hidden compensation lives in places most employers never look
- Transparency is worthless without someone who knows how to use the data
If you're a CFO, CHRO, HR Director, consultant, or fiduciary of a health plan, this conversation will change how you see the entire benefits ecosystem.
What You’ll Learn:
- Why CAA broker transparency rules failed
- How hidden compensation still influences broker recommendations
- Why employers must build fiduciary governance like their 401(k) plans
- The difference between named vs. functional fiduciaries
- How data, machine-readable files, and AI tools will reshape oversight
- Why market concentration and hospital power keep prices high
- How reference-based pricing and captives fit into employer strategy
- What upcoming congressional reforms might change
Time Stamps:
00:00 – Preview
00:53 – Show Opener
01:18 – Donovan’s Introduction
02:04 – Meet Alden Bianchi
02:49 – Alden’s Background (ACA, ERISA, Romney Reform)
03:39 – Why Employer Healthcare Costs Exploded
05:10 – Fiduciary Exposure and 401(k) Lessons
07:17 – Donovan on Lack of Data in Healthcare
08:49 – ACA vs. CAA: What Transparency Actually Changed
10:12 – Machine-Readable Files: Why They Matter
10:59 – Broker Compensation Rules Are “A Joke”
12:14 – Why Disclosures Don’t Work (Undisclosed Incentives)
14:02 – Donovan on Conflicts in Broker Comp
15:30 – The True Fiduciary Standard for Employers
16:14 – Alden’s B.O.L.O.s: Override Commissions, Referral Fees
17:48 – Fiduciaries Must Become Quant Analysts
18:54 – Who Is a Fiduciary? Alden’s Simple Definition
20:36 – Why Fiduciary Exposure Is Personal
21:13 – SHRM, CAA Compliance, and Employer Pushback
21:56 – Challenges With Gag Clauses, RxDC, and Disclosures
23:33 – Why Naming a Fiduciary Protects the Board
25:40 – PBM Lawsuits: Standing Problems Explained
27:35 – Why ERISA Remedies Are So Hard to Win
29:20 – How PBM Practices Impact Premiums & Wages
30:31 – Employers Subsidizing Medicare Rates
31:13 – The $35,000 Family Plan Problem
31:44 – Extreme Cases of 16x–21x Medicare Pricing
32:29 – Alden on Reference-Based Pricing’s Role
33:29 – Why Obamacare Didn’t Lower Costs
34:27 – Hospital Profits, Medicare Rates & Misconceptions
35:08 – Are Hospitals Really Underpaid?
36:18 – Where Employers Should Actually Start
37:43 – Incentive Problems in Broker/Consultant Models
38:29 – Group Captives, AHPs, and Small Employer Solutions
39:47 – Why Transparent Products Matter
40:20 – Claims...
