A 1,000-employee senior living management company across Kansas and Colorado challenged the status quo — and proved that a fiduciary-first approach delivers better outcomes for everyone.
Axiom Healthcare Services is a management company for senior living communities across Kansas and Colorado. With approximately 1,000 employees across skilled nursing facilities, assisted living, memory care, home plus residences, and a senior care hospital, Axiom’s mission is captured in their motto: I.L.E.E. — Improving Lives, Exceeding Expectations. All five of their skilled nursing facilities were recognized by U.S. News & World Report as 2024 Best Nursing Homes.
Former Series 65 RIA who applies fiduciary-level standards from securities to healthcare consulting. Fee-only. Zero vendor conflicts. Full data transparency.
Every engagement starts with a no-obligation diagnostic of your current plan — the same process that uncovered $577K+ in savings for Axiom. No carrier quotes. No sales pitch. Just data.
When Ethos first looked at Axiom’s situation, the picture was clear: a company stuck in a reactive cycle with no real strategy, no data, and a broker who was benefiting from rising premiums. Here’s how the transformation unfolded — in Brenda’s own words.
For years, Axiom was caught in the same cycle that traps most employers. Every year, the renewal would arrive with a large increase. The broker would go back, “negotiate” a slightly less painful number — still an increase — and everyone would call it a win. As Brenda described it: she just got tired of the same cycle year after year.
The turning point came at a conference, where Axiom’s CHRO Shanda met Donovan and Chelsea Ryckis. Even though Axiom wasn’t in the market for a new consultant, the fiduciary approach made an immediate impression.
There’s an old saying in employee benefits that originated from brokers: “the cost of the claims.” To me, this never made any sense. A claim is a request for dollars for a covered incident under an insurance policy — and that number can be wildly variable. Every American knows this to be true for hospital bills and certainly for pharmacy costs as well.
The real blind spot at Axiom wasn’t the claims themselves — it was not having adequate claims data to properly benchmark their plan, understand the problems internally, and bring solutions toward them. A claim does not equal a condition. While we can’t change the conditions employees have, what every plan sponsor can do is more responsibly reimburse for those conditions — which is the claim.
When Ethos reviewed the available data, the picture was stark. The carrier’s summarized “conditions reports” — aggregate spend on heart, spine, and other categories — were essentially useless for benchmarking or negotiation. As Donovan explained: “Imagine a 401(k) where the advisor says, I can’t tell you what investments are in here, how much they cost, how much they’ve returned — you’d fire them immediately. But in healthcare, that’s standard.”
Without granular data — hospital-level detail, CPT codes, actual reimbursement amounts — you can’t identify the problems, you can’t audit the costs, and you certainly can’t bring solutions. The first step in any benefits transformation isn’t changing carriers or cutting costs. It’s unlocking the data.
When that first renewal came in for us, it was +2.6%. The company was ecstatic — by most metrics, that’s a huge win for a plan sponsor. But we told them to hold off. We didn’t think it was fair. We negotiated that same renewal down to −8% without changing plan specs or enrollments, then found a carrier that provided the data and audit rights needed for years 3, 4, and beyond. The end result: −13% with full transparency and a clear path forward
But the savings didn’t stop at the company level. Axiom passed the benefits to employees: premiums dropped 27 to 38% depending on plan, and deductibles decreased across the board. Better coverage at significantly lower cost — not by shifting burden, but by fixing the system.
The most important move in Year 1 wasn’t changing carriers or restructuring the plan — it was getting the claims data and transparency back. Without that, everything else is guesswork. You can’t benchmark. You can’t identify problems. You can’t bring solutions. And you certainly can’t negotiate from a position of strength.
The prior arrangement had Axiom on a fully insured plan where the carrier treated claims data as proprietary. We negotiated for a structure that gave us full data access and audit rights — the raw material we’d need to understand where the money was actually going and, more importantly, where it was being wasted.
That transparency is the foundation for everything that comes next. With real data in hand, we can now design a proper plan in Years 2 and 3 — unbundling the four functions of the healthcare plan, marketing each independently, implementing pharmacy reform, and continuing to bring premium decreases to Axiom. Step one was always about reclaiming the information they should have had all along.
Now that Axiom had created external alignment by establishing a fiduciary relationship with Ethos Benefits, we worked with them to create internal alignment as well. Together, we formed a benefits committee with a charter, regular meetings, KPIs, and ongoing education.
By bringing together the CEO, CFO, and CHRO, each person brings their expertise to the table — and collectively, as a company, Axiom will ask better questions and therefore get better results. The CFO understands the financial exposure. The CHRO understands how plan design affects recruitment and retention. The CEO understands the strategic picture. When those perspectives work together instead of in silos, the company makes fundamentally better decisions for its employees.
The committee now requires 408(b)(2)-style compensation disclosures from all service providers. No hidden commissions. No bundled incentives. Every dollar is documented, and every recommendation is evaluated against the fiduciary standard — not just the suitable one.
Axiom is now in Year 1 of a multi-year strategic plan. The PBM has been fixed. The data is flowing. The committee is meeting regularly. Future phases include unbundling additional plan components to negotiate each on its own merits, expanding pharmacy optimization as new biosimilars enter the market, and building the kind of long-term cost trend that compounds savings year over year.
For Brenda, the excitement is about what’s possible now that the foundation is in place: “We’re very excited and can’t wait to see how the three-to-five-year plan unfolds for us.”
The executives who drove the change — from both sides of the engagement.
The executive who made the decision to partner with Ethos and commit to a long-term fiduciary benefits strategy — prioritizing a culture that takes care of people while staying disciplined operationally.
Former Series 65 RIA who brought fiduciary-level standards from retirement plans to healthcare. Donovan’s approach treats the health plan as healthcare financing — not insurance.
The financial leader who recognized the need for change and championed the fiduciary approach. Brenda’s perspective as both a plan fiduciary and a plan participant gives her unique insight into what works.
2024 BenefitsPRO Advisor of the Year. Co-leads the fiduciary framework methodology and drives client relationships from discovery through implementation.
25+ years in healthcare HR. Made the initial connection with Ethos at a conference — even though Axiom wasn’t actively looking. Her instinct to explore the fiduciary approach opened the door.
Day-to-day client lead for Axiom’s engagement. Patrick manages the ongoing relationship, coordinates renewals and vendor negotiations, and ensures the strategic plan stays on track between committee meetings.
In Brenda’s and Donovan’s own words — what the engagement changed about how Axiom thinks about healthcare.
“Realizing that we have a fiduciary liability — that it doesn’t just extend to the 401(k) plan — was the big change. We put a committee in place to make sure we’re being good fiduciaries for our employees.” — Brenda
“We wouldn’t want to incentivize our employees for bad performance. So why would we want to incentivize our brokers for bad performance?” Axiom now requires full compensation disclosures on every line.
“If we don’t have data, we don’t know where our costs are being spent. We have to have that data to see where our dollars are going — and whether our plan is designed to match our needs.” — Brenda
Premiums dropped 27–38%. Deductibles decreased. Mail-order Rx at no cost. All of it happened without asking a single employee to change their pharmacy, their doctor, or their medications.
“We can come up with an arrangement where the consultant is making a fair wage and we’re benefiting — not only by saving money, but by making sure we have the best plan possible.” — Brenda
“CEO, CFO, and HR is the basic starting point. Each person in their role asks questions important to what they do. Collectively, the company gets better outcomes for plan participants.” — Donovan
Hear the full story directly from Brenda Kruse, CFO of Axiom Healthcare Services, alongside Donovan Ryckis. This episode covers the broken renewal cycle, PBM reform, fiduciary governance, and the results that changed everything.
“The sad and shocking thing is the standard of care in insurance is just ‘suitable.’ Any insurance product I could sell to Axiom is suitable for them to purchase. That’s a very low bar. We can bring that fiduciary standard of care over to healthcare and sleep a heck of a lot better at night.”
This is called the health and welfare plan at the end of the day. And I think it’s important to take that seriousness into the decision-making process.
— Donovan Ryckis, Be More Than a Fiduciary Podcast
A proposal that looked good — until you checked the data
When I first reviewed the prior broker’s proposal, it hit all the buzzwords. Responsible. Strategic. It looked competent on the surface. But when I compared it against the actual claims data, the gaps were massive. 60% of Axiom’s claims were concentrated in pharmacy — and nothing in their proposal addressed or fixed this very clear problem. Instead of consulting and bringing in solutions to lower those RX costs, their whole proposal focused on broker solutions — selling a new, bigger risk transfer with no explanations on improving their underlying problems.
The recommendation was suitable — but certainly not optimal
The renewal the prior broker chose was obvious on a spreadsheet — but what Axiom couldn’t know was how it stacked up against the options that were never compared. The presentation took the easiest and most lucrative path for the broker. In insurance, the standard of care is just “suitable” — any product they could sell to Axiom is technically acceptable. But suitable isn’t good enough when you’re managing healthcare for 1,000 employees and their families. We don’t settle for the obvious choice — we build the comparison that reveals the optimal one.
It’s never in a plan sponsor’s interest to be kept in the dark
In addition to ignoring the pharmacy data in their renewal proposal, the prior broker moved Axiom from a health plan with data access to the most restrictive option on the market for data and audit rights. While fixing the RX issue this year would have been straightforward, any renewal in the following year will be significantly tougher. Negotiations only get harder when you can’t identify, audit, or quantify claims — only the carrier can see it. They traded short-term simplicity for long-term blindness, and that’s a decision that compounds every year.
Bottom line: When that first renewal came in for us, it was +2.6%. As soon as it was released, the company was ecstatic — by most metrics, for a plan sponsor, that’s a huge win. We told them to hold off. We didn’t think it was fair.
From that point, we negotiated that same +2.6% renewal down to −8% — without changing any plan specs or enrollments. Then we went back to work to find a carrier that could provide the data and audit rights we’d need to execute in years 3, 4, and beyond. The end result: −13% with full transparency. That gave us a clear path forward — we could finally understand the claims costs and the problems Axiom would face going forward.
What was immediately clear to me was how easy it would have been for a broker to just pass the +2.6%, collect the commission, and move on to the next case.