By David Hawkes, chief technology officer, MphasiS Health Care Solutions
Introducing consumer-driven health care products to corporate employees reflects a commitment to melding health care insurance with the latest trends in financial management control that many consumers desire. Health care payers, including benefits plan sponsors, self-insured companies and third-party administrators (TPAs), need to implement connectivity and automated health benefits solutions in order to expand health plan flexibility. Yet because payers are using claims adjudication and payment systems developed for traditional plans, they lack the underlying infrastructure to optimize the wide array of financial transactions available. Some entities offering health savings accounts (HSAs), health reimbursement arrangements and flexible spending accounts underestimate the management complexity involved. Even a global financial services powerhouse, American Express, which introduced a payment card for HSAs less than two years ago, recently pulled out of the market, according to BankNet 360.
Is this surprising? Maybe not. Customer service issues are a mounting concern, as indicated by a Forrester study in February, entitled Will Plans Abandon $1.4B In Annual CDHP Profits? "If ignored, these issues will eventually stifle growth and limit CDHP market share to just one-fourth of the market, costing plans $1.4 billion in lost profits by 2012," the report concludes. It also notes that consumer-directed health plans would grow aggressively even if customer service remains a sore point, but that not improving service would be a lost opportunity. Outsourcing some plan components to a business process outsourcer (BPO) specializing in technology solutions can keep new plans running smoothly and profitably.
The Integrated Alternative
An outsourcer can help identify whether the traditional low-cost, low-complexity claims, or the high-cost, complex claims segment presents a unique opportunity for significantly reducing your company´s administrative expenses through an integrated alternative to traditional health coverage.
Administrators need not be forced to contend with multiple systems to house and track CDHC products. Rather, a BPO´s systems can manage these plans in concert with all enrollee transactions. As a result, workflow is far more streamlined, providing administrators with a comprehensive view of account activity. Indeed, system capabilities can include, but are not limited to, these features:
• Member-level plan and account spending definitions,
• Convenient contribution fund management,
• Automated rule-based reimbursement, auto-recoveries and adjustment,
• Electronic transaction exchange with pharmacy benefits managers and financial custodians,
• Regulatory and client reporting.
Link with Prepaid Benefits Card
Additionally, a well-designed system allows employees to view the latest transactions from their account cards linked to their CDHC accounts; in other words, they can view financial summaries in real-time and see the details they need. The most advanced systems provide this data because it is integrated with a prepaid benefits card. How? The system electronically synchronizes account balances, tracking and verifying eligible expenses. Tedious, paper-based substantiation and reimbursement processes for claims administrators and employees are virtually eliminated. Even better, covered individuals can tap into account balances directly instead of having to pay out-of-pocket and then submit a receipt for reimbursement.
Simplicity must extend to the customer service personnel. When talking with BPO representatives about the technology they use, ask them to demonstrate whether their administrative platform efficiently integrates plan design, provider contracting, eligibility, claims, case management, customer service, online servicing and reporting—all in real-time. Also verify that the platform´s work queues can be set up in customer service, claims and other parts of the system to route items automatically for resolution based upon a pre-defined set of user parameters. (Hint: You´re looking for a "yes" here.) These factors are too important to be left to chance. Introducing CDHC products that turn into an expensive flop serves no one´s best interests, least of all plan sponsors and TPAs. A qualified, innovative BPO enables companies to allocate internal resources and time appropriately on the claims, payment and service segments for which they are best suited.
David Hawkes is product manager for MphasiS Health Care Solutions, an EDS company based in
