Tag: Blog

**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.

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

As prescription drug costs continue to climb, it’s no secret that patients today are hit with more out-of-pocket costs for the drugs they use. While health organizations are slowly shifting and empowering patients to take control of their own healthcare, finding the facts about which drugs are covered under which plans, and how much you will pay, can be a time consuming nightmare. The first step in simplifying this process for consumers is to provide transparency.

Addressing the issue head on, the Robert Wood Johnson Foundation recently kicked off their latest challenge dedicated to the coverage and cost of prescription drugs. At the same time, Vericred has just released formulary datasets for the individual under 65, small group and large group health insurance markets. You can read more details about our formulary datasets here. Working in collaboration with the Robert Wood Johnson Foundation, the team at Vericred is making our formulary API available to all Rx Cost and Coverage Challenge entrants at no cost for the purpose of the challenge.

According to Katherine Hempstead, senior advisor at the Robert Wood Johnson Foundation, “Access to and affordability of prescription drugs are extremely important elements of plan choice for many consumers, particularly for those who may suffer from chronic conditions.” Read Katherine’s full post from last week on The Health Care Blog. Through the Rx Cost and Coverage challenge, the Robert Wood Johnson Foundation is hoping to find a solution that addresses prescription drug access and affordability.

If you’re a developer and have what it takes, we urge you to learn more about the Rx Cost and Coverage Challenge. You can read more details about the background of the challenge here. This is a big opportunity to be involved in developing a potentially – make that hopefully –game-changing solution that puts knowledge at the fingertips of consumers around the nation.

First round submissions are due August 14, 2016, and the winners will be featured at the Health 2.0 Conference, not to mention $100,000 in cash awards. We wish you luck and can’t wait to see what you create!

The other day, I was in the car when I heard a commercial for a bariatric clinic offering lap-band surgery.  The commercial ended with these words: “…your PPO insurance should pay.”   This might lead someone to believe that their insurance would cover the entire procedure.  It.  Does.  Not.

This is by no means the only statement that may, purposely or not, mislead a consumer. The financial consequences of seeing an out-of-network provider are profound.  Absent some kind of negotiation, you’ll be responsible for the “list price” of any medical care you receive.  If your insurance plan is a PPO or a POS (a plan with out-of-network benefits), you’ll be billed for the difference between a procedure’s list price, and the amount allowed under your health plan.  That allowed amount may be a fraction of the list price, and you’re on the hook for the remainder.  This is called balance billing.  And if you have an EPO or HMO that limits you to in-network providers, you’ll be responsible for the full list price of any service rendered by an out-of-network provider.

The problem’s made worse because some healthcare providers play a little fast and loose with the terms.  A doctor who says they “accept” or “take” a plan, may simply be saying that they will bill the plan.  You’ll be responsible for any balance due.

So what do you do?  First, make sure your provider is in-network.  You can check with your insurance carrier or on your plan’s doctor search site.  But be careful. Your insurance carrier may offer many plans and many networks.  Make sure your provider participates in your particular plan.

And when speaking with a provider, you have to be very specific about asking “are you an in-network provider in my health plan.”  This leaves little room for ambiguity.  It’s also recommended that you make sure that any ancillary services are performed by in-network providers.  Your annual physical, for example, may include a blood draw, EKG and lab work – all done by different providers even though everything was taken care of in the same physical office.  So make sure those providers are also in-network.

It’s the only way to avoid having a costly out-of-network experience.