Category: Blog

**Ideon is the company formerly known as Vericred. Vericred began operating as Ideon on May 18, 2022.**

 

This is the second of three posts on this subject

To increase transparency, plans offered under the ACA are given metal levels based on how the cost of care is split between an individual and their health plan. Silver plans must cover 70% of a typical population’s healthcare costs, but plans can use a wide variety of different cost-sharing structures to arrive at this 70%. The deductible—the amount the individual must cover before their plan begins to pay—is one factor that can make a big difference to out-of-pocket costs.

In our last post, we examined the median deductible for small group silver plans by state and found that there is substantial geographic variation by state. In this post, we will explore the variation in deductibles within states.

The data science team at Vericred investigated the range of deductibles for small group silver plans within each state. The results show that every state has silver plans with a wide range of deductibles. Employers shopping for a small group plan should consider which aspects of cost-sharing matter most to their employees, as plans with the same metal level in the same market can vary widely in their cost-sharing.

**Ideon is the company formerly known as Vericred. Vericred began operating as Ideon on May 18, 2022.**

 

This is the first of three posts on this subject

To increase transparency, plans offered under the ACA are given metal levels based on how the cost of care is split between an individual and their health plan. Silver plans must cover 70% of a typical population’s healthcare costs, but plans can use a wide variety of different cost-sharing structures to arrive at this 70%. The deductible – the amount the individual must cover before their plan begins to pay – is one factor that can make a big difference to out-of-pocket costs.

The data science team at Vericred analyzed deductibles for small group silver plans to see how they vary by state. The national median deductible for silver plans is $3,000, but the results show that there is substantial geographic variation ranging from only $2,000 in Massachusetts and California to $4,250 in New Mexico and Iowa.

**Ideon is the company formerly known as Vericred. Vericred began operating as Ideon on May 18, 2022.**

 

This is the final post of a three-post series on this subject.

Which prescription drugs do we spend the most money on as a nation, and how are they covered in the ACA market? In this post, we will explore the differences in coverage of certain cost driving drugs between the individual and small group markets.

According to the Express Scripts 2016 Drug Trend report, the prescription drugs in the chart below drive significant aggregate cost based on unit cost as well as utilization. The cost of drugs to an employee and his/her family is determined their employer’s health plan’s design and drug formulary.  Formularies are lists of prescription drugs with each drug each in a “tier.”  Typical plan tiers, from least expensive to most expensive, are as follows: generic, preferred brand, non-preferred brand and specialty.

In prior posts, we looked at coverage analyses of these ten cost-driving drugs in both the individual and small group markets. To do so, we looked at formularies for these ACA health plans across the nation to see how each of these drugs is covered. The results show a significant difference in coverage between individual and small group health plans.

In general, health plans for individuals cover these high cost drugs at higher cost tiers, while small group health plans cover these high cost drugs at lower cost tiers. The difference in coverage between these two markets is meaningful.  As small(er) businesses are considering whether they directly offer a health plan or encourage their employees to seek coverage through the individual market, they may want to take into consideration these differences in coverage.

In future posts, we will explore the differences in plan premiums between the individual and group markets.

**Ideon is the company formerly known as Vericred. Vericred began operating as Ideon on May 18, 2022.**

 

This is the second post of a three-post series on this subject.

Which prescription drugs do we spend the most money on as a nation, and how are they covered in the ACA market? In this post, we will explore the coverage of certain cost driving drugs in the small group market.

According to the Express Scripts 2016 Drug Trend report, the prescription drugs in the chart below drive significant aggregate cost based on unit cost as well as utilization. The cost of drugs to an employee and his/her family is determined by their employer’s health plan’s design and drug formulary.  Formularies are lists of prescription drugs with each drug listed in a “tier.”  Typical plan tiers, from least expensive to most expensive, are as follows: generic, preferred brand, non-preferred brand and specialty.

The data science team at Vericred developed a coverage analysis of these ten cost driving drugs in the small group market. We looked at formularies for small group health plans across the nation to see how each of these drugs is covered. The results show that a majority of small group ACA plans cover these drugs in the preferred brand or non-preferred brand tiers, but approximately one third of plans cover these drugs in the specialty tier; the most expensive tier other than not being covered at all. Given the wide variation in coverage, employers may want to consider whether or not their employees and/or dependents are taking these high cost medications when choosing a health plan.

 

**Ideon is the company formerly known as Vericred. Vericred began operating as Ideon on May 18, 2022.**

 

This is the first post of a three-post series on this subject.

Which prescription drugs do we spend the most money on as a nation, and how are they covered in the ACA market? In this post, we will explore the coverage of certain cost driving drugs in the individual market.

According to the Express Scripts 2016 Drug Trend report, the prescription drugs in the chart below drive significant aggregate cost based on unit cost as well as utilization. The cost of drugs to an individual is determined by their health plan’s design and drug formulary.  Formularies are lists of prescription drugs that sort each drug into a “tier.”  Typical plan tiers, from least expensive to most expensive, are as follows: generic, preferred brand, non-preferred brand and specialty.

The data science team at Vericred developed a coverage analysis of these ten cost driving drugs in the individual market. We looked at formularies for health plans available to individuals, through healthcare.gov or state based insurance exchanges, across the nation to see how each of these drugs is covered. The results show that, for all but Truvada, a majority of individual ACA plans cover these drugs in the specialty tier; the most expensive tier other than not being covered at all. Given the wide variation in coverage, if an individual is taking one of these pricy drugs, shopping around to find a plan that covers it would certainly pay off.

 

In many organizations, the benefits conversation occurs once a year, at open enrollment time. Interim conversations take place only when there is a life event – marriage, a new baby – that changes things. There is, however, plenty of room for regular communication with employees about benefits – communication that can take place by leveraging a benefits administration platform. Effectively using a ben admin platform as a communication tool can help employers increase employee engagement, improve company culture, and lift morale. It even has the potential to lower healthcare costs. That’s because an employee who’s educated on how they can make better health decisions is more likely to actually make those better health decisions. Let’s look at some areas where there are opportunities to keep employees engaged and returning to a company’s platform on a consistent basis.

Health Benefit Decision Support

Because benefits related to healthcare are such a large part of the benefits portfolio, and are such a critical area of employee concern, health benefit information is a good place to start. There are many different types of decision support tools that could (and should) be incorporated into a benefits platform – tools that will be extremely valuable to employees on a year-round basis. Here are a few examples:

• Offering a universal Provider Search feature helps employees find a provider who’s in-network. Instead of employees having to go to different sites to find a doctor or dentist, each with a different user interface, a universal directory provides a consistent user destination and experience; one that remains consistent even if the employee/er changes carriers.
• Take provider search one step further and proactively notify employees if their provider has dropped out of their network. Communicating this information at the right time will minimize surprise out-of-network bills, improving your employee experience (and saving them money) throughout the year.
• Physician appointment booking features provide value throughout the year making it easy to schedule and book appointments. Amino goes even further into this decision support category by providing cost and quality transparency and proactively matching individuals with the in-network physicians best suited to that patient’s needs and preferences.
• Tools that aid in deductible tracking and/or HSA spending are quite useful in helping employees stay on top of their finances … and on the platform.
• Prescription drug search helps employees understand if their recently prescribed drugs are covered by their plan, the cost that the employee will incur for that drug and perhaps offer advice on generic equivalents. Drug co-pay coupons and cash drug services such as GoodRx can also be offered.
• Telemedicine is an increasingly popular feature, one that employees love, allowing them to speak to a doctor via web, phone or mobile app in a matter of minutes.

These are just a few examples of the types of tools that can turn a static, seldom-used benefits platform into an interactive, highly-relevant environment that employees will turn to throughout the year.

Wellness Tips

Wellness tips are always useful and relevant in a ben admin platform. Here, communication is key and message simplicity is paramount. Communications around wellness must provide clear, easy to understand instructions on how employees can improve their wellness. A good example is a “one up, two down” program encouraging employees to take the stairs one flight up or two flights down before pressing the elevator button. Some employers may want to add incentives to the mix, and a ben admin platform is an excellent vehicle for introducing incentives and gamification of wellness tools.

Other Benefits Information

It’s not always about decision support tools or gamification. A benefits platform can also be used as a primary channel for educating employees about all sorts of different benefits. These can include information on ancillary healthcare benefits like vision and dental insurance; education on the types of life and disability insurance employees might want to consider; and education on the importance of saving for the future in retirement accounts. A benefits platform can also be the central hub for information on less usual benefits, such as pet insurance and student loan reimbursement. While some of these coverages are only available at open enrollment, educational material can (and should) be delivered throughout the year.

Keep the Benefits Conversation Going

Different employees respond to and engage with different communication channels. Many employees like emails, posters, town halls, and group meetings. But employers should also modernize, especially when it comes to reaching those Millennials that communicate via technology. In addition to communicating through the more traditional channels, it’s a good idea to prime a ben admin platform to deliver information via:

• Personalized dashboards
• Mobile alerts and in app notifications delivered to employee smart phones
• Videos rather than the written word

Some of the most cutting edge organizations might even try integrating Emma, a recently-announced voice-activated assistant from Alegeus (which offers healthcare and benefit payments solutions). Emma is a first cousin to Apple’s Siri or Amazon’s Alexa: consumers ask a question about their healthcare accounts and Emma finds the answer. When it comes to benefits technology, there are clearly many exciting new developments to keep the conversation active.

Businesses should not let the dust gather on their benefits administration platform. By taking advantage of the features and add-ons that are available today, companies can turn their ben admin platform into a tool that makes benefits a year round conversation. The result? Greater employee engagement and higher morale, as benefits are more optimally utilized.

**Ideon is the company formerly known as Vericred. Vericred began operating as Ideon on May 18, 2022.**

Almost Here: Round-the-Corner Future Technology, a FutureTech Podcast that discusses the future technologies transforming our lives recently spent some time with Michael Levin, Vericred Co-Founder and CEO, to talk about healthcare, insurance and data.

In the podcast, they discuss today’s health insurtech landscape, the digital health insurance environment and some of the challenges that come with building tools to help consumers and businesses make better decisions about their health insurance.

“Healthcare.gov created a marketplace where individuals can select from different health insurance plans. This was revolutionary because it instilled knowledge in individuals that there is choice. Five years ago, consumers did not understand how many choices were available to them. And today, the new health insurtech industry is building tools to surface choice and help individuals and employers make better health insurance decisions.”  – Michael Levin

Click here for the full podcast to learn more about the health insurtech industry, understand new solutions that are available, and get a peek into Vericred’s future plans.

**Ideon is the company formerly known as Vericred. Vericred began operating as Ideon on May 18, 2022.**

For the past 10-15 years, APIs have been considered the “modern” way for two software systems to interact. But an API isn’t the solution to every problem.

At Vericred, we provide large volumes of health and benefit data to partners for integration into their platform or their product, and when we were developing our integration points, we were faced with a decision: do we go API-only or do we support other methods of data transfer?  Ultimately, we landed on a hybrid approach where we provide product feature-level access to our data via API, and platform integration via a set of flat files.  This approach has proved to be flexible for us, and has allowed us to develop deep integrations with minimal friction and start-up costs for our customers while minimizing bloat within our codebase.

Is this the right approach for you? Below I offer four considerations to keep in mind when deciding how you’ll integrate your data.

1. Usage of the Data (Platform vs. Product Feature)

Is the data going to be used to build a product feature or to power a platform?  This speaks to the flexibility that our customers will need when using the data.  For example, our provider-network search data answers a few simple but commonly asked questions.  The primary questions is “is Dr. X in-network for this plan?”  This lends itself nicely to an API endpoint (and, in fact, we only offer this data via API).  We would consider this a product feature: it solves a very specific need. While it’s an important part of the user experience, its functionality doesn’t bleed over into too many other user journeys in our customers’ apps.

Conversely, for many customers, our health plan data is core to their platform.  It’s displayed in multiple user journeys throughout their apps. This lends itself well to a bulk data transfer process.  Our customers would rather have this data in their own database.

2. Volume and Frequency of Update

How frequently is this data updated?  The cost, in terms of development and operations time, of pulling a large data set into their database is considerable for our customers.  If the data set is updated extremely frequently (and if the number of updates is very large), these issues are magnified.

In the previous example, our provider-network data has hundreds of millions of records and changes very frequently.  We see churn as high as 8% per month in certain networks.  The volume of the dataset is an indicator that a flat file might not be an optimal solution.

Conversely, plan data is updated once a year and rate data is updated once per year in the individual market and once per quarter in the small group market.  While in practice the data changes quite a bit more than that due to corrections, new data becoming available, and other factors, the volume and frequency of updates are far lower than provider-network data.  This makes it a candidate for the flat file approach.

3. Relationships Between Entities in the Data

One of the key design principles of a REST API is that it is entity-based.  While this has the advantage of a predictable location for each entity (e.g., Plan 123 always lives at /plans/123), it has the disadvantage of making it a bit more difficult to string together many related entities.

In the above example, if Plan 123 happens to cost $X in zip code 12345 and $Y in zip code 23456, and it also happens to be available in 12345 and 23456, but not in 34567, the customer would need to make additional API requests to determine all of that information.  When the object graph is fairly large and the customer needs to access the entire object graph to persist it to their database, flat files tend to be a better choice than API-only.

4. Format Requirements

Many of Vericred’s customers have vastly different schemata, and in order to reduce friction and increase adoption of our data platform, we made the decision to offer customized formats to those customers.  An API is, ideally, a single consistent representation of a set of resources.  Maintaining multiple formats or schemata in a single API is complex, and will often accrue technical debt within a codebase.

We made the decision to push this complexity out of the API and further down the chain.  The “standard” set of flat files we offer is generated from our API directly, but any customizations are post-processes that operate on our standard set of files.  This allows us to build out features in our core API while still meeting the needs of customers who have specific format requirements.

As a data services company, we’ve learned through working with customers over the course of the past 2 ½ years that there isn’t a one-size-fits-all solution to data transfer.  APIs are a great solution for many use-cases, but they are not the only solution.  There are several cases where transfer via flat files has proven very useful and has allowed us to separate out the general and client-specific pieces of our architecture to provide us substantial flexibility in working with our customers.

**Ideon is the company formerly known as Vericred. Vericred began operating as Ideon on May 18, 2022.**

Let’s face it, the world we live in is becoming more and more digitally focused. Technology has become the primary means to reach modern consumers. Innovation is a must for success in the future of health insurance. This is the reality facing insurance carriers today. While changes in technology present several challenges, they also create significant opportunity.

The Modern Health Insurance Consumer

According to Pew Research, millennials are now the largest generation in the U.S., with a population peak predicted for 2036. These young consumers are digitally savvy. They’re digital natives and have never known anything but the innovative digital world. Technological advancements, and the millennials’ ability to make rapid adjustments to their technology habits as innovations are introduced, are the norm. 73% of millennials make purchases directly on their mobile devices. Using social media, they look for the opinions of their peers before making purchases. And, according to a recent study cited on Entrepreneur.com, they routinely comparison shop on mobile to get the best value and shopping experience – a habit that the market is just starting to capitalize on.

The millennial generation are becoming today’s business decision makers. They’re small business owners. They’re working their way into the C-Suite. And they’re health care consumers. Thirsty for smart solutions, immediate choices and intuitive user experiences from every brand they interact with, they have extremely high standards. And who can blame them? This is the generation of Google, Amazon, Apple and Uber.

A New Industry Catering to the Healthcare Customer Experience

Purchasing health insurance may never be as easy as booking a flight on Expedia, but health insurance will follow the industry footsteps of travel, cellular and retail. Consumers demand it. And because consumers are demanding it, an entirely new industry has come into existence in the last few years: digital health, an industry composed of technology companies that are pushing today’s innovation envelope. Digital health companies range from health insurance sales and enrollment apps, to HR and benefit platforms, to health insurance utilization tools, doctor referral apps, health engagement platforms, care management websites … the list goes on and on. They’re health and insurtech platforms like Zenefits, Stride Health, bWell, ZocDoc, GluecosePath, and Zest Health, companies transforming the way health insurance is purchased and used. They’re nimble, flexible, and 100% focused on using technology to improve the customer experience – whether their customers are individuals, employers, brokers or patients. Technology is what they do, and health insurance data is what they use in their products.

Insurance Carriers, Meet Cutting-Edge Health Insurtech Companies

While large insurance companies have endless amounts of expertise and knowledge, it can be a challenge for them to stay nimble, flexible and transparent – which is what the future is demanding. How will insurance carriers respond to consumer demands for a more technically up-to-date experience? They’ll do it by leveraging the platforms of today’s digital health and insurtech companies, which have the technical expertise to build innovative experiences that attract the modern consumer. To take advantage of health insurtech platforms, carriers need “only” connect to them.

Unfortunately, it can be challenging to connect with modern insurtech platforms. The legacy technology that the carriers run on doesn’t always sync with the new capabilities being built in today’s market. It’s as if they’re two separate technology languages – and they usually are.  So how does a forward-thinking insurance carrier bridge the gap between their data (often housed in older systems) and the emerging platforms that will enable them to provide the customer experience that today’s insurance consumers demand?

Vericred has a way.

Think of Vericred as the go between, the bridge that closes the gap between carriers and today’s insurtech platforms. Vericred provides a modern-day data translation layer, a health insurance data platform (comprised of benefit design and rate, provider-network and formulary data) which allows carriers to leverage digital health companies without investing in infrastructure or technology. Insurance carriers provide Vericred access to their data. Vericred then normalizes and structures that data and operates as a single-source API, delivering it to those building the digital, consumer, employer and broker-facing platforms that are starting to take off. Inclusion in this centralized data layer will allow carriers to reach their consumers through today’s technology, without their having to be a data or tech company. Vericred is already working with some of the most prominent health insurtech platforms on the market. It’s the point solution that connects carriers with today’s digital platforms, allowing insurance companies to stay focused on health insurance

Health insurance consumers are increasingly tech savvy. They’re the digital natives who demand and expect that they’ll be able to take care of all the business of their personal and professional lives online – whether that business is booking a trip, hailing an UberX, or buying their health insurance. Opportunity awaits the millennial-minded insurance carrier that’s able to provide a modern customer experience for today’s health insurance consumers.

**Ideon is the company formerly known as Vericred. Vericred began operating as Ideon on May 18, 2022.**

EpiPens are grabbing national headlines for their soaring prices.  The life-saving drug device treats anaphylaxis, a potentially fatal allergic reaction to certain foods, bee stings, medications, or latex. Amidst the rising calls for hearings and policy change, should be personal commitments to making informed decisions during the upcoming Open Enrollment Period.

Prescription Drugs and Health Plan Choices

Simply put, the prescription drugs you and your family members take should influence your choice of health plan. With over 50% of adults taking prescription drugs on a regular basis, and with these drugs accounting for more than 20% of the U.S. healthcare spend, attention should be paid to this often overlooked, but critical, element of plan selection.

Whether or not a drug is covered by a particular plan is governed by the “formulary” attached to that plan.  Formularies are lists of drugs, often found in PDF’s on carrier websites, that show whether or not a drug is covered, and at what “tier level”, along with any restrictions.  The tier level is important, as it drives what the individual will actually pay for that drug.  For example, tier 1 drugs often have a very low co-pay, perhaps $10. Meanwhile, tier 4 drugs may require the individual to pay 50% of the drug’s cost.

The price an individual pays differs, sometimes dramatically, from the wholesale and retail prices often raised in the press.  And at the end of the day, as individuals (as opposed to employers, especially self-insured employers), we care about what we actually pay out of pocket for a drug – not what occurs behind the scenes.

Formularies differ, sometimes considerably.  I have a son with peanut allergies and have bought EpiPens for years.  Last year, our health plan didn’t cover the EpiPen at all.  So we paid $600 out of pocket.  This year, the EpiPen is covered and we paid $100 for the exact same product.  This shows the significant difference between the two formularies attached to our plans this year versus  last.

The issue applies equally to seniors, especially with Medicare Advantage and Medicare Part D plans.  An article in the AARP Bulletin in November 2015 by Patricia Barry entitled “Save Money on Medicare in 2016” described the significant difference in cost a covered senior would pay for common drugs under different formularies attached to these Part D plans.  In the most extreme example, the monthly difference between the highest and lowest cost for Procrit was $535.  My personal experience was a swing of $500 a year. Imagine that on a monthly basis!

So how does one protect themselves from the shock of drugs that aren’t covered, or that are covered, but at a high out of pocket cost?

The first thing to do is check with your physician about generic alternatives as these are:

1. much more likely to be covered by a plan
2. will cost significantly less

The second thing to do is check the formularies of all available plans for the drugs you take on a regular basis.

Some health insurance shopping platforms are bringing transparency to this critical plan element through “shop by drug” functionality. This lets users enter the drugs they take to see if their drugs are covered by each available plan and, if so, at what tier level and cost.  This addresses the challenge of identifying and searching dozens of formularies.  Platforms like GetInsured.com and Take Command Health serve the individual under-65 market, while Medicare Pathfinder serves the senior (over 65) market.  Such platforms make easy work of identifying the “right” health plans based on the drugs you take and the doctors you see, all in the context of the costs and coverages of each plan.

So as we approach open enrollment, let’s use the EpiPen debate as a teaching moment to better inform ourselves and find the right plan.