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Topic: Decision Support

Five datasets powering today’s healthcare navigation platforms

Posted on by Ideon

Over the past few years, three trends have intersected: healthcare costs increased, the healthcare system became more complex, and digitally native employees started expecting employers to provide technology for HR and benefits tasks.

Enter healthcare navigation platforms — digital tools that guide employees to better, more informed healthcare decisions based on cost, quality, and other criteria.

These platforms provide a wealth of information on doctors, hospitals, prescription drugs, and medical procedures. They also help employers to manage their healthcare costs by providing transparency into the pricing and quality of healthcare services.

Of course, offering an intuitive, modern user interface is essential for any healthcare navigation platform. But the breadth and quality of data behind the scenes, powering the features, often have the biggest impact on the overall user experience.

Here are five key data elements that some leading navigation platforms have integrated into their experience.

Provider network data
This includes information about the doctors and hospitals in a particular health plan’s network, including provider locations, specialties, and more. This is a foundational dataset, providing employees with detailed information about the PCPs and other healthcare providers in their network. Navigation platforms can help employees to make more informed decisions about where to receive care, as in-network providers are usually more cost-efficient than out-of-network.

Provider quality data
This covers the quality of care provided by different doctors and hospitals, as well as patient satisfaction ratings. This may also include outcome-based metrics. Platforms integrate provider quality data into their experiences to help employees choose healthcare providers that are more likely to provide excellent care.

Cost information
This is data about the cost of different medical procedures, prescription drugs, and other healthcare services. By providing employees with transparent pricing information, these platforms can help them shop for healthcare and make more cost-effective choices.

Patient reviews
Reviews and ratings of different healthcare providers from other patients who have received care from them. Armed with this information, employees can find healthcare providers that are more likely to provide a positive patient experience.

Claims data
Information about the healthcare services that employees have received, including the cost of those services and any out-of-pocket expenses that they may have incurred. By giving employees access to claims data, these platforms can enable them to better understand their healthcare benefits and how to use them.

All of these data sources are crucial for powering the new age of healthcare navigation platforms. By aggregating this data and presenting it to employees in an easily understandable format, these platforms can help to demystify the healthcare system and empower employees to make better decisions, resulting in significant cost savings for employers and improved health outcomes for employees.

For navigation platforms, collecting and integrating all of this data from disparate sources may seem like a colossal undertaking, but that’s generally not the case. Much of this information is now readily available via APIs. For example, Ideon offers structured, normalized provider-network data to navigation platforms via an API.

There are several healthcare navigation platforms on the market today, each with its own unique set of features and capabilities. Some examples include Healthcare Bluebook, Garner Health, HealthJoy, Accolade, Castlight Health, and others. Though their user experiences vary significantly, all rely on the power of data.

Shop-by-doc is now ‘must-have’ for leading InsurTech platforms

Posted on by Ideon

HMO or PPO? Copay vs. coinsurance? What’s the cost-sharing structure for out-of-network specialist visits, mental health services, and home health care? Shopping for a health insurance plan is a notoriously painful process — whether you’re seeking individual coverage, choosing between plans offered by your employer, or examining your Medicare Advantage options, it’s often difficult to identify the plan that best matches your specific requirements. And it’s certainly not getting any easier: more carriers are offering more plans than ever before.

Like modern shopping experiences in other industries, the bulk of health plan selection now occurs online, via digital health insurance exchanges of both the public and private variety. For these digital platforms, used by consumers, seniors, brokers, and businesses alike, it’s critical to deliver intuitive, data-driven user experiences that provide full transparency into the rates, cost-sharing, subsidy estimates, and other features of all available health plans. However, a robust plan library, side-by-side plan comparison, and a modern quoting interface are insufficient to meet the needs of today’s users.

Shop-By-Doctor: provider-centric plan selection

To many consumers, there is no more significant determinant than whether a plan offers in-network coverage of their preferred providers, hospitals, and facilities. This has become even more important in recent years, as out-of-pocket maximums have increased and high-deductible plans have gained prevalence. To avoid the potentially high cost of out-of-network care, most consumers begin their plan shopping process with one question: “Which plans cover my family’s doctors and our local hospitals?”

Multi-carrier digital platforms have made answering this question far simpler than when paper SBCs and carrier-specific portals ruled the plan selection and enrollment landscape. Today, many multi-carrier exchanges and state-based marketplaces have integrated shop-by-doc functionality — the ability to filter available plans to show only the options that cover users’ preferred doctors and providers — into the plan shopping process.

Offering shop-by-doc has material benefits. Consumers avoid out-of-network fees and purchase a plan based on what’s actually important to them. Ideon, currently powering shop-by-doc functionality on several leading private marketplaces and state-based exchanges, has found that about 70% of consumers shopping for health plans will add their providers as a search criterion. For health insurance platforms, shop-by-doc is no longer an optional feature — it’s an essential component of a modern, integrated, fully-digital plan shopping experience.

Integrating shop-by-doc functionality into the shopping experience

Despite shop-by-doc’s obvious benefits, there remain some holdouts among consumer and broker-facing platforms. Adding this functionality was, traditionally, a near-impossible endeavor. The industry lacked a centralized, standardized source of provider-network data from which platforms could power provider-centric plan shopping features. Acquiring this information, in a usable format, from hundreds of health insurance carriers was beyond their operational and resource constraints.

But that technical barrier no longer exists. Ideon has transformed shop-by-doc into a simple addition to any existing platform, by building APIs that enable platforms with quoting functionality to integrate shop-by-doc into their system, without acquiring and maintaining the underlying provider-network data. These APIs are a bridge to better user experiences, and, ultimately, better-informed health and financial decisions and a smoother enrollment process for all.

If you’re interested in delivering shop-by-doc functionality to your platform’s users, reach out to learn how Ideon’s data solutions enable tech companies to build robust decision support experiences.

Decision Support Tools Are Modernizing the Employee Benefits Experience

Posted on by Ideon

Here’s how leading carriers and third-party platforms guide employees through their benefits journey with decision support technology.

It was inevitable.

The application of data, predictive analytics, and an intuitive user experience to legacy plan selection, enrollment, and year-round engagement processes is a benefits industry game-changer whose time has come.

From choosing the right benefits package to finding high-quality, cost-effective healthcare, today’s employees expect technology to help them make better benefits decisions. Combining data with advanced digital experiences, modern carriers and a new generation of technology platforms are doing precisely that.

To better understand the challenges and opportunities posed by decision support technology, John Emge, Senior Vice President, Carrier Sales at Ideon, recently moderated a webinar featuring three industry experts who are immersed in improving the employee experience through decision support tools: Dan Murdoch, CMO at Nayya; Jill Schlofer, 2nd VP, Implementation and Enrollment at The Standard; and Travis Symoniak, Senior Product Manager, Group Benefits Enrollment at Securian Financial.

In a briskly paced and engaging webinar, the four discussed:

  • The evolution from simple decision trees to advanced, data-driven experiences
  • The data powering decision support platforms
  • What’s driving increased employee demand for benefits decision tools
  • Lessons learned developing and deploying decision support tech
  • The future of decision support

Below we share five of the most actionable insights from the session.

You can watch the full webinar here.

1. Decision support must be an experience

Decision support should encompass an entire ecosystem that engages, educates, and provides recommendations before, during, and after the enrollment process, said Symoniak.

Decision support platforms today can leverage customer-disclosed data to make recommendations that are hyper-personalized, offering employees a strong and empowered understanding of what types of benefits they should pick and — just as important — why. “Whether I’m trying to plan for a voluntary surgery, or my kid’s braces, there is this accumulation of unique circumstances that we all experience,” Murdoch explained. “Benefits need to fit our unique mental, physical, and financial situations.”

To attain that level of personalization, employees must have a level of trust around sharing their data, and employers must follow all privacy and security best practices. But the upside is considerable. “The more you give, the more you get,” said Murdoch. “

It’s also important, Schlofer said, to circle back and help the employer understand whether they made the right choices of benefits for their employees.

2. Decision support gives employees confidence they’re making smart, informed choices

Benefits are the single most important financial decision we make each year, explained Murdoch. They are an essential tool for risk mitigation and planning for the seen and unforeseen. It’s critical that employers offer decision support that empowers employees.

The concept of demonstrating benefits and claims scenarios to employees is extremely powerful, Symoniak said: “We have invested in allowing employees to customize different claim scenarios and put themselves in others’ shoes. When you have a fall, or you hit your head playing softball, what does that claim process look like? What is the payment going to look like, what are you actually going to use those insurance products for?” Employees come away feeling confident they’re making smart, informed choices.

3. Decision support must extend beyond enrollment

Symoniak said the next step in the evolution of decision support is to extend it past periods of enrollment and qualifying events. The future is year-round engagement, as employees are shopping for medical care, getting a recommendation, and getting additional support.

Decision support should become the “go-to” for employees, employers, and brokers when employees experience important changes in their lives, notes Schlofer.

Murdoch noted that consistently evaluating the employee benefits experience is essential to building a best-in-class offering: How are you evaluating your strategy? How are you reviewing employee feedback? The composition of your workforce? How are you choosing your carrier and reviewing their plans to build a holistic offering?

4. Recent market changes are driving demand for decision support

“Two or three years ago there was not this level of interest in decision support,” noted Symoniak.

Indeed, the current labor crisis and rising inflation are major factors in the growing demand for decision support.

Employers are trying to figure out how to attract and retain the best employees, Schlofer explained. How can you use benefits to your advantage? In the recruitment process, help an employee understand what benefits choices they might have if they were to come on board.

Murdoch agreed: “It is absolutely to your competitive advantage to bring benefits decision support to recruitment and hiring. Hiring managers can tell candidates that the company has put together a best-in-class offering, and you don’t have to memorize all the options — we have a platform that helps inform your choices.”

Schlofer explained that inflation is also a factor: Employees should spend more time making these decisions, which can have a critical impact on their personal finances. Now is not the time to drop your benefits because you believe you can’t afford them.

Murdoch noted the economic advantage of decision support to employers. “This is definitely not the time to cut the number of benefits and the amount that’s being spent. But there is an opportunity to spend more intelligently across the entire spectrum of your workforce. Using decision support to identify the right plans for the right people for the right reasons can be economically advantageous to the employer.”

5. The future: A holistic approach to benefits

The industry will continue to move past the legacy driven, challenging dynamic of the traditional benefits selection process. Predicted Murdoch: “I see the future of decision support hitting all the major categories that are required to inform the best recommendations, taking into account lifestyle, habits, and health history. Employers will see ROI on such a holistic approach.” Further, he explained that a best-in-class benefits experience will increasingly feel familiar and intuitive, a step-by-step experience that feels to the user like, for instance, Amazon or TurboTax.

Symoniak said in order to achieve a holistic, year-round approach to decision support, it will be crucial to continue breaking down barriers to linking data to carriers. “We are going to need more real-time integration across the industry to support benefits decisions. Carriers need to partner with benefits administrators and third-party administrators to get additional information. It’s the topic of the time,” Symoniak said. “Yes to more APIs!”

 

For more insights into how decision support tools can elevate the employee benefits experience, watch the full webinar here.

Guiding employees to high-quality, affordable healthcare: A Q&A with Healthcare Bluebook

Posted on by Ideon

Historically, consumers have found it challenging to master the complexities of the U.S. healthcare system, especially in regard to finding high-quality, in-network care at an affordable cost.

But a slew of innovative technology companies are changing all that. Healthcare-navigation platforms are revolutionizing the consumer experience, providing data-driven tech and digital-concierge services that enable people to make more informed decisions and get better value.

One such company is Healthcare Bluebook, a leading healthcare quality and price navigation platform. Ideon spoke with Bill Kampine, Healthcare Bluebook’s co-founder and Chief Innovation Officer, about the rise of consumer-centric healthcare tools, the data behind great digital experiences, and the new Transparency in Coverage regulations.

The below interview has been condensed and edited for clarity.

 

IDEON: What is Healthcare Bluebook’s core business?

BILL KAMPINE: Since 2007, we’ve had a simple purpose — to protect patients by helping them understand differences in price and quality within networks, and to provide digital tools that enable consumers to compare providers and get better value. With more information, consumers can make better choices among the options that are available within their network. Today, we’re one of the largest providers of healthcare price and quality navigation solutions.

 

Who uses your platform?

Our customers are large self-insured employers, state and local governments, TPAs, and other organizations. Overall, more than five million employees use our platform for healthcare navigation.

 

How does Healthcare Bluebook’s technology help those employees?

Healthcare is incredibly complex, difficult to navigate, and most employees don’t understand the industry’s language and jargon. We make it easy to overcome those challenges. Our intuitive user experience makes it easy for people to compare and locate providers and facilities, and understand the cost implications of their healthcare decisions.

Our platform also incorporates comprehensive, outcomes-based quality information. We use data-driven methodology to score hospitals, doctors, and outpatient facilities based on standardized outcome metrics. This allows patients to choose providers using quality information, in addition to cost data.

 

How do you encourage employees to utilize the navigation tools available to them?

Innovative technology and access to data are great, but engagement is equally as important. We wrap cutting-edge digital engagement and concierge support around our solutions, making it easy for members to make sound decisions, whether they’re using a computer or on a mobile device. 

Additionally, we work with our clients to align benefits with the desired outcome — use of high value care. We do this through benefit design and shared-savings incentives that reward members when they make good choices on care.

 

What types of data enable employees to find quality healthcare at affordable costs?

When I think about the transparency rules and other legislation, it has focused on the price of services. But to get value as a consumer, cost is only one half of the equation. For real transparency—to help members get better value—you need to provide cost and quality information. Our view is that those are two distinct pieces of information.

It’s also important to help consumers understand where they are against their deductible, their accumulator, and have out-of-pocket information. Even when deductibles and out-of-pocket maximums have been met, it’s important for people to understand their options from a cost and quality standpoint.

 

Is provider-network data—information about which doctors and facilities participate in which networks—integrated into your user experience?

Yes, and it’s hugely important. Our goal is to help consumers review all of their in-network options and steer them to high-quality and high-value care. We also want consumers, if they’re making an in-network vs. out-of-network decision, to understand the cost implications of choosing an out-of-network provider. Consumers should easily understand which providers are in-network and the potential financial significance of selecting out-of-network care.

 

What are some typical questions that healthcare navigation platforms answer for consumers?

The question is: I need a provider. Can I look them up easily? Importantly, which providers are in-network? Do they specialize in the service I need? What should I reasonably pay for a service and does a provider charge a fair price?  Where am I being referred for care, and what is the cost at that location?  Can I find or ask for alternatives that can lower my cost? What is the general overall quality of outcomes for the provider’s patients?

Within Bluebook, we provide information to help people make better decisions at each stage of the care pathway — healthcare navigation platforms should deliver that information in an intuitive, understandable way.

 

How is Healthcare Bluebook reacting to the new Transparency in Coverage regulations?

As a company, Healthcare Bluebook has planned for how these regulations, including the Transparency in Coverage Rules and the No Surprises Act, will impact our clients.  Since Jan. 2021 we’ve had clients live on initial prototypes that incorporate these new requirements into the Healthcare Bluebook platform. The early and ongoing development and testing ensures that our employer and TPA clients will have access to fully compliant Bluebook solutions for the 500 shoppable services required on January 1st, 2023 and full service coverage on January 1, 2024.

 

Looking ahead, will the new transparency policies drive more innovation in the benefits ecosystem?

I firmly believe innovations in using healthcare price information will come from third-party technology companies like Healthcare Bluebook and other digital platforms, rather than the traditional stakeholders.

For years, carriers, hospitals, and provider systems resisted transparency and disclosing this information to consumers. It’s the third-party technology companies that are extremely focused on helping employers and consumers get better value — innovations will come from those companies, and I anticipate entirely new platforms will be developed around the newly available transparency data.

 

What about Covid-19? Has the pandemic impacted your business?

Absolutely, there’s heightened employee demand for intuitive healthcare navigation tools. The pandemic introduced patients, on a large scale, to telehealth and remote care delivery. And most patients really enjoyed that experience. Telehealth is here to stay, and it’s shaped consumers’ expectations about convenience and technology in healthcare. One consequence of that is higher levels of digital engagement and utilization of navigation tools — consumers have greater expectations of convenience and support, especially around finding the care that they need.  Those expectations have impacted our thinking and how we better engage and support patients.

 

Interested in learning more about Ideon’s provider-network data solutions? Check out our industry-leading APIs or connect with our sales team.

Reclaim’s Story: How Ideon’s APIs saved time and reduced risk

Posted on by Ideon

“I think of Ideon as infrastructure-as-a-service”

Reclaim helps individuals and families manage their healthcare bills by providing a bevy of insurance-related services. The company’s app allows users to access bills, learn how they might offset costs, discover how they might have received more cost-effective service elsewhere, and more.

 Reclaim is out to simplify the insurance experience for the consumer—but they were also eager to simplify their own internal operations.

Enter Ideon’s API, an accurate and comprehensive source for provider-network data—information on which doctors and facilities participate in each insurance network.

Before Ideon we were getting data from carriers, but each one’s schema is different. That makes the ETL [extract, transform, load] process difficult because we were doing several data manipulations per carrier. Now it’s just one schema that we have to worry about—Ideon’s. 

Using Ideon also means we don’t have to worry about delays. It’s derisking for us.

So says Reclaim’s co-founder and CEO, Nataly Youssef. Interested in hearing the whole story? Download our case study here.

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APIs, decision support, and more: An employee benefits trend report in six quotes

Posted on by Ideon

Ideon’s place at the center of the health insurance and employee benefits industry means we have a clear view of the technology trends shaping the entire ecosystem. But we’re hardly the only ones talking about the growing importance of APIs, digital connectivity, and other transformative innovations.

Here are six trends ushering in the digital age of employee benefits, plus what industry leaders are saying about them.

The healthcare industry embraced interoperability. Employee benefits isn’t far behind.

“Interoperability has been a huge buzzword in the healthcare industry in the last few years, and we’re now seeing it in the employee benefits space for the first time. Data is siloed between various systems and the next wave of technological innovation will be focused on connecting these systems. Not only does it eliminate manual tasks and reduce errors, but it can unlock the ability to make better decisions and drive better outcomes for all.” — Ryan Sachtjen, ThreeFlow

 

Employees expect health insurance and benefits experiences to be as easy as online shopping.

“The goal is to make benefits-enrollment and selection changes take place in real time, replacing a traditionally manual, error-prone process with long wait times before coverage takes effect. Smart technology allows real-time data exchange with benefit carrier partners to simplify processes and improve the benefits experience.” — Amanda Pope, ADP

 

Decision support—which is growing in utilization—requires data connectivity and transparency. 

“The reality of decision support today is that the extent to which such tools can help users is greatly dependent on the quality and breadth of information they have to work with.” — Michael Levin, Ideon

 

Voluntary benefits—crucial in the fight for talent—depend on accurate, smooth-flowing data.

“Tailoring and recommending the benefit packages that best meet employee lifestyle needs eliminates the tedious employee task of sifting through voluntary benefit options. A data-driven approach to benefits can yield higher employee participation in benefits programs as well as improved employee tenure and retention.” — Neil Vaswani, Corestream

 

Efficient, API-powered connectivity is a game-changer for carriers.

“Overall, APIs are helping to provide a personalized experience, rather than a one-size-fits-all solution. Looking ahead, carriers can expose APIs to broker partners and insurtech companies, to transact uniquely, improve operating efficiencies, and enhance experiences. The carriers that are able to easily interact with these partners and play within this ecosystem will have an advantage.” — James Ocampo, Wellfleet Workplace

 

API middleware is enabling carriers and BenAdmin platforms to exchange data with remarkable speed, flexibility, accuracy, and scalability.

“Having a middleware partner allows our engineers to work on our product. I don’t have to build out a gigantic team to focus on each of the carriers. Middleware keeps our operating costs low, and brokers can trust our platform to enroll groups with a multitude of different carriers without our having to build out connections to each of them.” — Cory Nicks, Rippling

 

Interested in more Ideon content and the latest benefits technology trends and analysis? Subscribe to our newsletter below!

 

GetInsured’s Story: How Ideon saved the company time and resources—and boosted stakeholder confidence

Posted on by Ideon

“It’s a streamlined process when we’re working with a trusted, experienced data partner”

GetInsured powers state-based health insurance marketplaces by providing health insurance technology and customer service solutions for state governments. An important feature of the company’s offering is that consumers have the ability to shop for plans by healthcare provider, which helps individuals keep their doctors when enrolling in a new plan.

Back in the day, sourcing provider-network data was quite the headache. Says GetInsured’s director of product management, Archana Dekate:

Before Ideon we were getting our data directly from carriers or through other vendors. And each vendor had their own APIs and their own set of implementation procedures, which meant that we would have to modify our code every time to accept their data, then QA it, test it, and so on. It was time consuming; every product release would take anywhere from one to three months of setup time.

Thanks to Ideon, that’s all safely in the rearview mirror. To learn how partnering with Ideon helped GetInsured on multiple fronts, download our case study here.

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Powerful from the start: How data integrations helped DocMe launch an innovative digital health app

Posted on by Zach Wallens

By Zach Wallens
Director of Content and Communications, Ideon

In this blog post, Ideon profiles one of our newest customers, DocMe, a digital health app based in New York.

It’s no secret that new technologies and companies are driving innovation in the healthcare industry. From mental health and virtual care to digital pharmacies, care navigation, and billing, digital health startups are popping up in all corners of the healthcare ecosystem.

That ecosystem, however, is getting crowded. The race for customers, funding, and publicity is more competitive than ever before.

One way to stand out? Build intuitive, data-driven user experiences powered by third-party data integrations. New York-based DocMe, a brand new digital health app, is one example of an innovation-through-integration approach, leveraging several APIs to create a powerful interface for patients and providers.

Connecting the Dots

Founded in 2021 by private equity investor Tim Gollin, the original concept for DocMe was an app to help consumers shop for doctors, comparing availability, insurance coverage, and prices for specific procedures. Of course, there are existing services, such as ZocDoc, for booking medical appointments.

Gollin quickly realized that a connected patient experience—bringing together disparate data sets within a single platform—could truly differentiate DocMe from competitors. Leveraging third-party integrations, Gollin and his developers understood, would be far more efficient than chasing down data sets and building functionality from scratch.

DocMe streamlined its development by relying on specialized companies to provide data and services it incorporated into its app. “A lot of the data and connections we would have had to build ourselves in the past we can now get from vendors,” Gollin says. “We see ourselves as stringing together little bits of Tinker Toys to build a complete product.”

Indeed, DocMe integrates third-party technology for functions like electronic health records, payments processing, video conferencing, and provider identity verification. And it incorporates multiple sources of data about providers, procedure costs, and—with data from Ideon—insurance networks.

“Ideon provides me with the ability to show consumers which doctors are in their network without them having to go to their insurance company website,” Gollin says. “Doctors don’t even know what networks they are in. We’ve heard lots of stories where people get told on the phone the doctor is in their plan only to discover it’s not. Ideon has the definitive answer.”

This tight integration between services provides patients with an easier, more intuitive experience. Some examples:

  • DocMe promises patients that they’ll never have to enter medical information history more than once. 
  • When someone makes a doctor’s appointment, they not only see available times but also the specific services offered and the price they’ll pay according to the terms of their insurance plan.
  • When a patient books an appointment, DocMe will collect the amount not covered by insurance in advance. In other words, patients get a much more transparent market.

DocMe is continuing to add features to its product, integrating data more tightly to save users time. It will use Ideon’s card scanning technology, for example, to extract patients’ network information by simply snapping a photo of their insurance cards. 

DocMe is also preparing to roll out in Brazil, Italy, France, and the United Arab Emirates. Some might ask why a small company would spread its resources across different countries, each with its own health care system. Gollin answers that the work done to build integrated capabilities and smooth user experience into DocMe already gives it an advantage in other markets. “The goofy thing is the U.S. system is super complicated,” he says. “Everyplace else is significantly simpler.”

For more information about Ideon’s APIs for digital health and InsurTech platforms, click here.