Tag: Blog

**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

The Affordable Care Act regulates both the individual and small group health insurance markets, yet these two markets are seldom looked at side by side. While many of the regulations governing plan design and premiums are the same, the markets serve very different populations and different health insurance carriers participate.

The data science team at Vericred analyzed premiums for the lowest cost silver plans on the individual and small group markets to see how they differ by state.* The results show that in nearly every state, the lowest cost silver plans are more expensive on the individual market than on the small group market. The only states where the individual plans are less expensive are Indiana, Ohio, New Jersey, New York, and Rhode Island. Additionally, Vermont has a combined individual and small group market, which ensures no difference in premiums. The largest differences between the individual and small group premiums are seen in Iowa and Wyoming, where the lowest cost individual silver plans cost over $300 more than small group. Small employers thinking about whether to offer group health insurance should consider the difference in premiums between the individual and small group markets that their employees will face.

* Results are similar if the median cost silver plan is used instead of the lowest cost silver plan

This is the first of three posts; in the next post, we will investigate how competition in the individual market is related to the premium difference between the small group and individual markets.

**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.

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 two posts, we examined the deductibles for small group silver plans and found that there is substantial variation in both the median deductible between states and the range of deductibles within each state. In this post, we will compare states’ median deductibles in the small group market to those on the individual market.

The data science team at Vericred analyzed the difference between the deductibles for small group and individual silver plans to see how this relationship varies by state. The results range from the median small group deductible being $2,500 less expensive in North Carolina to $1,750 more expensive in New Mexico. For the majority of states, the small group market has less expensive deductibles than the individual market, however, there are 14 states where the small group deductibles are more expensive. Small employers considering whether to offer group health insurance should consider which aspects of cost-sharing matter most to their employees and how cost-sharing differs between the individual and small group markets in their state.

**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.