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Topic: Enrollment

Introducing the Ideon Dashboard for real-time visibility of enrollment data

Posted on by Ideon

At Ideon, we’re dedicated to facilitating seamless enrollments and data exchange for our carrier and benefits platform customers. That means not only maintaining the fast, accurate, and scalable connections they expect, but also providing greater transparency and visibility—qualities that have been lacking in our industry.

That’s why we’re excited to introduce a major enhancement to our product suite: the Ideon Dashboard, a powerful new interface that compliments our existing API endpoints. With enhanced monitoring of group implementation statuses and the ability to submit, track, and resolve issues, this dashboard brings unparalleled visibility, efficiency, and collaboration to Ideon’s enrollment customers.

The dashboard enables effective three-way collaboration between carriers, benefits platforms, and Ideon, allowing for the swift resolution of issues when they arise. It eliminates the clutter of email threads and ensures no issues are overlooked, all in a centralized, user-friendly tool that keeps all parties in the loop.

Let’s take a closer look at some of the key features.

 

Improved Visibility with the Enrollment Tasks Manager

Historically, setting up and managing group enrollments required numerous steps and lots of back-and-forth communication between carriers and benefits platforms. Ideon’s dashboard changes this equation. Carriers and platforms can now access real-time updates on the status of enrollment data that’s been loaded into Ideon’s system. This added visibility minimizes confusion and prevents potential delays in member enrollment.

At a glance, customers can get an immediate overview of their data across all groups, including details such as carrier-specific identifiers and coverage start and end dates. For each coverage period, they can monitor the status and owner of all completed and upcoming setup tasks. 

Tasks can be assigned to specific users from the platform, Ideon, or the carrier, ensuring there’s alignment on next steps and responsibilities. Additionally, comments and attachments can be added to each task, providing necessary context and encouraging collaboration. This not only eliminates lengthy email exchanges but expedites the process of getting groups live.

Through the transparency and visibility provided by the Enrollment Tasks Manager, Ideon customers will always be informed about the status of their groups. They’ll have accurate and up-to-date information to share with members, brokers, and HR teams, ensuring a better enrollment experience with clear timelines and expectations.

Efficient Issue Resolution with the Customer Ticketing System

As carriers and benefits platforms’ operational teams know all too well, issues are bound to happen in our industry, whether it’s discrepant group information, a member inquiry, or another pressing matter.

The Ideon Dashboard offers streamlined issue resolution with its intuitive Customer Ticketing System. It centralizes communication and collaboration, allowing customers to easily submit, track, and resolve their questions, concerns, and escalations. With everything in one place, scattered communication channels like Slack and email are eliminated, and tickets are monitored right alongside the groups they belong to.

For each ticket, customers can provide notes, severity info, and useful attachments or documentation. Comment threads help maintain individualized communication with Ideon, and watcher functionality and email notifications keep customers in-the-know at all times.

Conclusion

The Ideon Dashboard is a powerful addition to Ideon’s enrollment solution, providing greater levels of visibility, efficiency, and collaboration to carriers and platforms—both during group setup and in production.

The new interface is designed to enhance the overall transparency and effectiveness of working with Ideon in a secure, centralized way. But it’s meant to complement, not replace Ideon’s suite of APIs.

All data and functionality offered by the dashboard are also available via Ideon’s existing API endpoints and webhooks. Using these features, our customers can seamlessly integrate status updates and other information into their own tooling and user experience. It’s all part of the unrivaled enrollment experience that Ideon delivers to our customers, their operations teams, and, ultimately, members, employers, and brokers.

Schedule a demo

The Ideon Dashboard has already seen great success among several of our carrier and benefits platform customers, and we can’t wait to show you all of its features. You can watch a short demo above, or reach out to schedule a personalized walkthrough.

 

How BenAdmin platforms turn carrier connectivity into a competitive advantage

Posted on by Ideon

Benefits administration platforms’ (BenAdmins) sales, operations, and product teams have a ton to think about these days: 

  • How do we become a year-round benefits destination for employees? 
  • How do we take advantage of the growing popularity of voluntary benefits? 
  • How do we ensure our employee experience is a competitive differentiator?

One topic that is all too often overlooked: carrier connectivity. On one hand, carrier connectivity has become table stakes — after all, doesn’t every BenAdmin platform communicate enrollments and member changes to carriers digitally, mostly via EDI feeds?

Yes, but leading BenAdmins view carrier connectivity as much more than a technical requirement: done correctly, it’s a competitive advantage, enabling scalability, efficient operations, and a fast, accurate enrollment experience.

In the benefits industry, “fast” and “scalable” are rarely used to describe group setup and implementation. We know from speaking with our customers that it takes most BenAdmins 8-12 weeks — and often longer — to build typical BenAdmin-to-carrier EDI feeds. But that’s all changing now. We’ve seen several platforms reduce their group setup timeline to as few as five days. 

The obvious question: How are BenAdmins reducing group setup to days, instead of months?

The answer lies in a new way of managing carrier connections, a strategic decision to partner with companies that specialize in exchanging enrollment data between BenAdmins and carriers. 

The results for BenAdmins speak for themselves:

  • Group setup completed in five days
  • The ability to send enrollment data in a consistent format
  • Elimination of several manual steps that typically prolong EDI implementation

Our new infographic compares, side-by-side, this enhanced carrier connectivity strategy vs. traditional EDI setup. Fast, accurate, and scalable — it’s a new world of connectivity without complexity. Download the infographic to learn more.

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Error management with Ideon, Part 2: Auto-reconciliation

Posted on by Jashan Ahuja

By Jashan Ahuja
Group Product Manager – Enrollment

In Part 1 of our error management blog series, we explored Ideon’s ability to process errors in a centralized and consistent way. Now, in Part 2, we delve into our industry-leading auto-reconciliation feature, which proactively identifies discrepancies between platform and carrier systems.

It’s a scenario all too common in the group benefits industry: a benefits administration (BenAdmin) platform sends enrollment data to a carrier via an EDI file and waits a week or more — with no visibility into whether the information was accepted — only to receive back an unreadable report of errors and discrepancies.

Now imagine a world with lightning-fast data exchange, two-way communication, and seamless reconciliation between platforms and carriers. The platform would receive a notification within minutes that lists all discrepancies between the two systems.

Ideon’s automatic reconciliation system makes the above not only possible, but easy to implement and scalable across carriers. It’s an industry-first feature that offers the capability of proactive data reconciliation between the platform and carrier systems.

In our prior blog, we explored Ideon’s ability to standardize and expose errors generated by carrier systems, transforming them into a consistent, human-readable, and actionable format. That crucial feature forms the foundation for closing the feedback loop with carriers. But Ideon doesn’t stop there. In this blog, we examine auto-reconciliation, a revolutionary process that identifies and surfaces discrepancies in near real-time, even before the data has been sent to the carrier. 

What is auto-reconciliation?

Auto-reconciliation is an essential component of Ideon’s data exchange process, significantly streamlining the enrollment workflow for carriers and benefits platforms alike. This innovative process flags discrepancies before data reaches the carrier’s system, dramatically reducing downstream errors that could otherwise wreak havoc on carrier operations—and members.

Here’s how it works: Ideon’s reconciliation engine proactively pulls all member and coverage information for a group from the carrier, converts it to our data model, and compares it to the platform data on a field-by-field basis.

The comparison encompasses 18 data points, also known as “discrepancy parameters,” including demographic data (e.g., birth date, SSN), coverage details (e.g., plan start date, plan volume), or even the existence of a member or their coverage in one system but not the other. We’re able to specify the source of any discrepancies for our partners and provide both platform and carrier values, creating a clear, actionable pathway to resolution.

Consider the example below, where a carrier’s system contains a different birth date compared to the one entered on the benefits platform. Without validation, this discrepancy would inevitably lead to errors for this subscriber. However, by matching the carrier’s existing information with the enrollment record, Ideon can promptly detect the discrepancy and return the record to the platform for correction.

"errors": [
    {
      "id": "a37ecd06-5d97-46e4-9b4e-dcde6a03246f",
      "member_id": "a37ecd06-5d97-46e4-9b4e-dcde6a03246f",
      "plan_id": "a37ecd06-5d97-46e4-9b4e-dcde6a03246f",
      "coverage_period_id": "a37ecd06-5d97-46e4-9b4e-dcde6a03246f",
      "discrepancy": {
        "parameter": "birth date",
        "carrier": "1/1/93",
        "platform": "2/1/93"
      }
    ]

 

During our processing, we reconcile 18 different critical fields, as well as verify the presence of the member in the carrier’s database. 

Annual earnings

Birth date

Coverage

Dependent

Employment end date

Employment start date

Employment status

Gender 

Marital status

Plan ID

Plan end date

Plan start date

Plan volume

Primary care provider

Residential address

Social security number

Subscriber

Wage frequency

 

Additional features

Ideon’s auto-reconciliation system boasts several features for fast, accurate data exchange, smooth operations, and an enhanced member experience.

Deduplication

Automatic reconciliation operates daily, comparing new discrepancies against open ones from the previous run and resolving any that are no longer relevant. This keeps carrier and platform systems in sync with current data and ensures the list of open discrepancies is directly relevant.

Frequency + Timing

Automatic Reconciliation runs as frequently as daily for carriers supporting an API-based, automatic census retrieval. Resolved discrepancies are closed every morning, while newly identified ones are opened.

We are currently expanding our auto-reconciliation functionality with carrier partners that don’t yet support a daily census.

As part of our reconciliation process, we carefully consider the timing of data in and out of our system. When our system receives a data element that hasn’t been sent to the carrier yet, our reconciliation logic takes this into account by comparing the carrier’s data with the previous version of that data field. Once the field is transmitted to the carrier, it is incorporated into the next reconciliation cycle, with a buffer for carrier processing time. This thoughtful approach prevents noise, such as unwarranted and erroneous discrepancies.

Surfacing Discrepancies

All actionable enrollment discrepancies—originating from either auto-reconciliation or carrier error reports—are returned in a consistent, normalized format. Partners can access this information through:

      • direct GET requests via our API endpoints
      • proactive push notifications using webhooks, or
      • our standardized Enrollment Discrepancies CSV, delivered periodically

By centralizing Enrollment Discrepancies, we enable a more efficient and streamlined operational process, allowing benefits platforms to view errors generated by carriers and the results of auto-reconciliation all in one place.


Impact

Leveraging our unique, central position between platform and carrier systems, we have quantified the volume of out-of-sync data. After analyzing data from hundreds of groups and thousands of members, we found that about 8% of employee enrollments have a critical coverage issue, i.e. incorrect coverage dates, plan information, or birth date, or they’re missing entirely from either the carrier or platform system. For one specific platform-carrier combination, we saw 10.3% of subscribers with at least one error that affects enrollment accuracy. Additionally, 80% of groups with more than 20 subscribers had one or more critical errors.

Overall, proactively identifying coverage-affecting errors is critical for reducing inaccurate enrollments and downstream issues. Automatic reconciliation allows groups to detect and resolve discrepancies before the initial transmission to the carrier. This improves success rates for the initial transition of groups into production and allows for faster, more accurate group setups, ultimately resulting in a better member experience.

Coming soon – Part 3: Account structure consolidation and mapping

Enrolling members in the correct plans with the correct carriers all starts with precise, streamlined setup processes. In the next blog in this series, we’ll detail how Ideon enhances a platform’s mapping capabilities, making it easier to configure complex group setups when employers have multiple plans, classes, and divisions.

Ideon Insights: Selerix’s Lyle Griffin talks LDEx and benefits data exchange

Posted on by Ideon

Welcome to the first installment of Ideon Insights, a new monthly interview series featuring thought leaders and innovators driving the benefits industry forward. In our first episode, we sat down with one of our technology partners, Lyle Griffin, president of Selerix, a leading benefits administration solution for brokers, employers, and carriers.

In this Q&A, Lyle shares his thoughts on the LIMRA Data Exchange (LDEx) standards, how the industry can facilitate more LDEx adoption, and how benefits data exchange will evolve over the next few years. Selerix and Ideon are both members of the Data Exchange Standards Committee tasked with developing the LDEx standards for the workplace benefits industry.

For Lyle’s complete thoughts on all-things LDEx, APIs, and data connectivity, watch the video here.

Below we’ve highlighted five key moments from the conversation.

IDEON: What’s the current state of LDEx adoption?

LYLE GRIFFIN, SELERIX: There are probably a dozen or so carriers that have stepped up and implemented LDEx in a really robust way. We’ve also been pleasantly surprised at the number of technology platforms that have been involved in developing the standard. That dialog between platforms and carriers is something that has been very refreshing.

What are the benefits of LDEx?

One, is just the speed of implementation, being able to set up your data connections quickly. Knowing that they’ll work as advertised is also very important.

As we move to API engagements, you’re really going to see the benefits. If we can move to something where we’re exchanging data in real-time, or as close to real-time as possible, the benefits back to the client or end-user are incredible.

Why is Selerix an advocate for data standards?

We’ve been very committed to implementing the standards since Day 1. What my team is telling me — the people who set up EDI connections with carriers — they’ve been very adamant that LDEx is good for them. They like it any time they can engage with people using the standard because it’s a concise way to start that dialog with the carrier. Having a common language really helps expedite the process.

How does Ideon help carriers and technology platforms use the LDEx format?

One of the most important things that [Ideon] brings to the table, is a fully formed view of how that data exchange ecosystem should work. Having a robust way to work with people on error resolution, initial engagement, data intake, being able to connect with an API or by exchanging files — I can see where this would be a very attractive proposition, not to have to build all of your business processes from scratch to take advantage of what a company like Ideon has to offer.

What’s the future of data exchange in the benefits industry?

In the long run, I think everyone’s vision is one of an interconnected ecosystem, an interconnected market, where trading partners exchange data more frequently and much more reliably than they do today. That’s what this is all about. As an industry, we’re still talking about this stuff, we’re still working on these challenges. So I think it’s going to take a while to realize that vision.

 

Stay tuned for new episodes of Ideon Insights each month. Subscribe to our newsletter below to stay in-the-know about Ideon and receive our latest content directly to your inbox.

Error management with Ideon, Part 1: A centralized, consistent experience

Posted on by Jashan Ahuja

By Jashan Ahuja
Group Product Manager – Enrollment

In Part 1 of a series detailing our enrollment API’s features and capabilities, Ideon’s product team examines error reporting and management — how it works, what benefits platforms can expect, and the advantages of a centralized workflow.

Historically, it’s been an operational and technical nightmare for benefits platforms to exchange group and employee enrollment information with medical and voluntary carriers. No matter the carrier’s method of data exchange — EDI, API, portals, etc. — getting data from platform to carrier was rarely a simple task.

But once connected, it’s smooth sailing, right? Not quite. As benefits platforms’ operational teams know all too well, sending data is only part of the equation. The carrier must accept and confirm the change, and that’s where things start to get really complicated. Usually, the biggest challenge is handling and rectifying enrollment data errors—every carrier sends discrepancies in a different format, and their error reports are rarely human-readable.

At Ideon, we’re powering a new era of connection between carriers and tech platforms. One that’s better, faster, and more secure than the industry status quo. In this blog, we explain Ideon’s error-handling features, from standardizing carrier error messages to resolving errors via API, and how they create a far more efficient and accurate enrollment experience.

What are enrollment discrepancies?

It’s hard to find someone with experience in benefits who doesn’t think that data errors and discrepancies are a problem. Some examples include account set up issues, incorrect employee demographic information (social security number, birth date, etc.), coverage date errors, and more.

Today, most carriers report errors in non-standard formats, often via email and spreadsheets. These reports are usually delivered on a weekly basis, and the information they contain is rarely easy to understand. The result is a slow, manual, and resource-intensive error-handling process that poses a challenge to benefits platforms and their operations teams.

What’s the impact?

We analyzed the data from hundreds of groups and thousands of members and found that about 8% of employee enrollments have a critical coverage issue, i.e. incorrect coverage dates, plan information, or birth date, or they’re missing entirely from either the carrier or platform system. Importantly, more than 80% of groups with 20+ members have critical errors.

And these errors have significant ramifications for the entire benefits ecosystem – from carriers and benefits platforms, to brokers, employers, and employees. The downstream impact ranges from lost revenue and broker commissions, to operational inefficiencies and employee experience issues.

Carriers are missing out on millions in potential premium. In one recent migration of about 200,000 employees onto the Ideon platform, our technology identified errors resulting in nearly $1 million in lost premium for the carrier.

For the employers in that migration, we saved more than 30K employees from potential coverage issues — all from one migration of approximately 200K lives. Ultimately, inaccurate data can cause serious problems for employees. Everyone in our industry can relate to the countless access-to-care issues that occur during open enrollment because of erroneous data. Or, imagine a life insurance claim for an employee who wasn’t enrolled accurately — there would be an emotional and financial impact on a grieving family, while the employer and platform would likely suffer reputational harm.

For a detailed look at how inaccurate data impacts every benefits industry stakeholder, read this recent blog by Ideon CEO Michael Levin.

Enrollment discrepancies via Ideon

The processes outlined above remain the industry status quo: manual error handling through spreadsheets and emails, inconsistent carrier formats, and a barrage of harmful errors that affect all stakeholders.

At Ideon, we’ve developed a revolutionary alternative for benefits platforms where enrollment discrepancies are centralized, standardized, and actionable. Here are three ways our solution differs from the typical process:

  • Many-to-one – Ideon translates all of the enrollment “errors” generated by carriers into a uniform and ingestible format.
  • Standardized messaging – Each enrollment discrepancy has a “message,” which is a standardized version of the carrier error translated into a human-readable format.
  • Centralized communication – Benefits platforms view and resolve all enrollment discrepancies, from multiple carriers, directly through Ideon’s API endpoint, allowing for a streamlined and centralized user experience and eliminating the need for other communication (e.g. e-mails and slack messages).

Centralized error management via Ideon’s API

Ideon’s error reporting solution helps platforms prioritize and rectify discrepancies by providing insight into the severity of each discrepancy and who’s responsible for fixing it. Regardless of the carrier or the original data source, platforms get a consistent, simple API experience.

In this section, we examine Ideon’s key error management features and highlight how platforms interact with our API.

(Image: Example of an API response sent from Ideon to a benefits platform. The response details an unresolved enrollment discrepancy, the party responsible for rectifying the issue, and other pertinent information.)

Severity – For each enrollment discrepancy we expose a Severity (“Info”, “Warning”, or “Failure”) that highlights the impact of the issue. A “Failure” enrollment discrepancy indicates a blocker to a member’s enrollment, whereas “Info” and “Warning” enrollment discrepancies provide visibility into informational updates or future changes required, for example when a dependent is due to age out in a couple of months.

Assignment – Each enrollment discrepancy has a Responsible Party and can be assigned to “Ideon” or “Partner”. This provides visibility into enrollment discrepancies that are currently being managed by our Enrollment Operations team and allows users to easily identify enrollment discrepancies that they need to address.

Status – Enrollment discrepancies have a status of “Unresolved”, “Resolved”, or “Returned”. This allows our teams to stay in-sync on each individual enrollment discrepancy. When we initially surface an enrollment discrepancy, it is in an “Unresolved” status. The status is updated to “Returned” when any comments are added and “Resolved” when a resolution message is provided.

Resolution – Partners are able to add a resolution message to an enrollment discrepancy via a simple API endpoint. This updates the status of the enrollment discrepancy to “Resolved”. If the issue still remains when the carrier re-attempts to process the data then the enrollment discrepancy can be reverted back to an “Unresolved” status so the history is retained.

Comments – Partners are able to interact with our operations team entirely via the enrollment discrepancies API endpoint by threading comments directly on the original enrollment discrepancy. This allows for efficient interaction between our respective Operational teams without needing additional tools or e-mails.

API and webhook transmission – Partners can pull down enrollment discrepancies directly from our API via a GET endpoint. We also provide enrollment discrepancies via Webhooks or a standard periodic CSV report.

(Image: Example of an API response sent from Ideon to a benefits platform. The response details a RESOLVED enrollment discrepancy.)

In summary, managing and rectifying enrollment data errors and discrepancies is a critical aspect of the benefits workflow. At Ideon, we understand the pain points of the industry and have developed a solution that streamlines the process by: standardizing error messaging; delivering a centralized resolution experience for benefits platforms; and helping them prioritize and, ultimately, resolve each discrepancy. Platforms can easily manage enrollment discrepancies, from multiple carriers, directly through our API endpoint, allowing for a streamlined experience without back-and-forth email communication.

Coming soon — Part 2: Auto reconciliation overview

Standardizing errors is a big step forward, but did you know Ideon can proactively identify them whether or not the carrier actually reports them? In the next blog in this series, we’ll dive into Ideon’s auto reconciliation feature, an industry-first capability that automatically compares data in the carrier and platform systems, surfacing discrepancies in near real-time.

HITRUST, the standard-setters in data security, now vouches for Ideon

Posted on by Dan Langevin

By Michael W.  Levin, co-founder and CEO of Ideon

At Ideon, our work is predicated on a straightforward belief: Choosing, buying, and managing health insurance and employee benefits should be no more complex than any other digital experience. And in creating the infrastructure that powers digital connectivity between carriers and technology platforms, we’ve been humbled to materially help improve the benefits experiences for countless Americans.

But even as we engineer and maintain the industry-best infrastructure that allows for free-flowing data, we are continuously ensuring that those “pipes” are not only unobstructed, but also airtight. To put it another way: We are obsessed with data security. Our APIs are the conduits for streams of personally identifiable information (PII) and protected health information (PHI)—and ensuring the safe passage of every last datum is a staggering responsibility we don’t take lightly. 

Nor have we ever. From its beginnings, Ideon prioritized transparency and security, working diligently to protect the sensitive member information that carriers, InsurTechs, BenAdmin platforms, and others send through Ideon’s platform.

Because cybersecurity threats are always mutating, data protection is a journey more than a destination. Last year, I reported that Ideon had met an important milestone of that journey when our data security protocols were validated by System and Organization Controls 2 Type II (SOC 2), an examination performed by a public accounting firm with expertise in information security audits. 

This year, I’m deeply proud to announce that Ideon’s Enrollment & Member Management API has earned certified status for information security from HITRUST. As detailed in a recent press release, this credential affirms that Ideon has addressed security risks through an exhaustive set of highly prescriptive controls. 

This step was necessary because unlike most other regulatory standards, HIPAA legislation provides no prescriptive white paper or rules for adherence. HITRUST was created by industry players looking to define standards around health information security. Its unparalleled rigor and scope makes HITRUST the gold standard for PHI treatment and storage.

Achieving the HITRUST certification was an arduous process. After conducting a gap analysis against nearly 300 controls, we began implementing the changes necessary for HITRUST compliance. It’s hard to overstate how monumental that effort was: We took measures to ensure that every Ideon action is logged and reproducible on demand. We instituted company-wide protocols governing mobile device use. We refined role-based accesses, installed cameras, updated policies and procedures, retrained staff, and prepared mounds of evidence.

And that description only scratches the surface. (For a technical dive into Ideon’s HITRUST certification, read this blog)

The process touched everyone at Ideon, consuming significant amounts of most employees’ time last year. An IT team was substantially dedicated to this effort for the past year, led by the remarkably talented Tim Hochman, our VP of information security and IT. Tim had previously taken another healthcare organization through the HITRUST initiation process, and he’s intimately familiar with its proceedings. (And, happily for us, he’s exceptionally organized—a must for a project so labyrinthine and minutely detailed!)

All told, it was a costly undertaking for the company, and at times even a challenging and uncomfortable one.

And yet: Aligning Ideon’s operations with HITRUST’s standards was as worthwhile as it was ambitious. In earning this designation, we signal to the industry that we understand the importance of handling sensitive information with the utmost gravity. We expect that this will usher in important new customers and partnerships.

But aside from the benefits that will no doubt accrue to Ideon, we’re excited about our HITRUST certification because it represents movement in a crucial direction for our industry. As migration toward APIs and data sharing intensifies, the need for increasingly tough security heightens across the space. 

Ideon has long been a pacesetter for innovation, vision, execution—and security. We’re eager to support the industry as it seeks to match progress with protection. If you have questions or want more information about Ideon’s security policies, please reach out to my team.

API connectivity and the bentech ecosystem: A Q&A with Sun Life’s Ted Phillips

Posted on by Zach Wallens

By Zach Wallens, Director of Content and Communications, Ideon

The HR and benefits technology (bentech) ecosystem has exploded in recent years, with billions in venture capital investment driving innovation and new players in the space.

That’s left insurance carriers with a strategic and technology challenge: how do we partner and connect with dozens of bentechs, ensuring brokers and members have a great experience across the platforms they use today?

Ted Phillips, Sun Life’s AVP, Distribution Digital Center of Excellence, tackles these challenges every day. Ideon spoke with Ted about Sun Life’s tech partnership strategy, the value of “enhanced” API connectivity, and their new partnership with Ideon.

 The below interview has been condensed and edited for clarity.

 

IDEON: What’s your role at Sun Life?

TED PHILLIPS: I lead a team that’s responsible for the strategy and execution of our benefits technology (bentech) platform partnerships. We’re looking to create new partnerships, bring them to market, and grow premium through these relationships. Through Sun Life Link, we work with our accelerator team on building out API connectivity, and our data operations team, which takes the connectivity we build and operationalizes it.

Our ultimate objective is to make benefits easier to manage — to remove headaches that are often felt in managing ancillary products. We want to streamline benefits administration, billing, and everything in between.

 

How has your partnership strategy evolved recently?

We’ve transformed our partnership strategy for three reasons: First, there’s an expectation now—among members, brokers, and employers—that technology works seamlessly. It’s incumbent upon Sun Life to make sure the benefits experience is great for everyone and that we meet their expectations.

Second, technology has advanced quite dramatically over the past 2-3 years. APIs and enhanced connectivity are the hot topics of today. Most of the bentech ecosystem are working toward some level of enhanced API connectivity.

Third, the bentech ecosystem is far more complex and nuanced than a few years ago. Before, there were benefits administration platforms (BenAdmins), but now there are many more layers and segments within our ecosystem: HCM, proposal tools, quote-to-enroll, broker tech, resellers, and more.

 

What does that complexity mean for your team?

In 2019, the global investment in HR tech was $5B. In 2020, it was $17B. What that creates is a whole host of companies that are extremely valuable, like Ideon, and others that are just getting their idea off the ground. For us, the challenge is making the right decisions on which bentech platforms to partner with.

We’re always evaluating two things: which segments of the ecosystem do we want to work with, and how can we connect with them? Sun Life can’t take in every connection request we receive from bentech platforms. Middleware like Ideon allows us to multiply our team’s impact by increasing the number of platforms we can connect to.

 

Sun Life recently partnered with Ideon to enhance your data exchange capabilities with bentech platforms. How does better connectivity affect your clients?

It’s all about making benefits easier. APIs and enhanced connectivity enable us to streamline eligibility, benefits administration, enrollment, etc., and that saves hundreds of hours for our brokers and clients.

We find that when employer groups are on platforms, especially those with which we have enhanced connections, they have access to more Sun Life products and better benefits education experiences.  Also, with better connectivity, the enrollment and administration process is faster and more accurate, leading to fewer claims and billing issues.

 

Let’s talk more about that. How do APIs improve data accuracy?

Technology, including APIs and enhanced connectivity, allows us to identify errors and correct them before they become significant client issues.

It starts with making sure benefits products are set up correctly on platforms. We then use APIs to ensure enrollment eligibility is completed quickly and accurately, to make sure benefits are available when they’re needed.

As enhanced connectivity becomes commonplace, there will be tremendous value in having more accurate data connections. It’s not just about speed — accuracy is just as important.

 

Does this help Sun Life’s operational team, too?

Absolutely, there’s a big impact on carriers. The Ideon system creates better data accuracy — which may equate to fewer support calls, fewer billing issues, and fewer claim issues. That can have a huge effect on the industry: we’ll all be much better off if we aren’t using paper and email to solve and reconcile these data errors. With better connectivity, they might not be issues at all.

 

We’ve talked a lot about carrier-bentech partnerships. How else is the industry working together?

There’s beginning to be a collaborative mentality in the benefits industry. Data accuracy and data exchange are industry-wide challenges, and neither will be solved by one carrier alone.

LIMRA is a great example of industry participants and even competitors working together to solve these challenges. There’s a mentality amongst a group of individuals that we need to fix this as an industry. If we do, everyone will be better for it.

 

Final question: Besides API connectivity, in what other areas is Sun Life investing in technology?

Sun Life is, first and foremost, an insurance company. But we have developed proprietary technology that provides a modern client experience. Sun Life Onboard, for example, is a digitally enhanced onboarding experience. Our Benefits Explorer tool helps educate members on benefits pre-enrollment and throughout the client lifecycle.

But it’s a balance. We also need to be where our clients are. As we’ve talked about, Sun Life has invested significantly in API-powered partnerships with bentechs in the market. Ideon is a big part of that.

We don’t think of these as separate buckets — in-house vs. external investment. We look at it holistically and invest accordingly. Ultimately, we want to make benefits easier to enroll, manage, and administer, on platforms and throughout the benefits ecosystem. We do it by developing technology and through partnerships with companies like Ideon.

 

Interested in learning more about Ideon? Check out our API middleware solution, connect with our sales team, or subscribe to our newsletter.

The health insurance and benefits industry has a data problem

Posted on by Ideon

In today’s world, data quality drives results—for good or bad. And for all the progress that’s been achieved harnessing data in the health insurance and benefits ecosystem, data problems are rampant.

We speak to you from the trenches, which is to say that Ideon is in the business of not only data connectivity, but also data accuracy. And in our experience, about 10% of employee enrollments have existing data problems—from incorrect social security numbers to inaccurate effective dates—that can and often does cause significant issues for members, employers, and carriers.

The fallout of poor data throughout the ecosystem includes: 

  • Members are arriving in doctors’ waiting rooms, only to be told their coverage is not in place. Scenarios like these are all too common. And while these problems are solvable retroactively, they cause undue frustration and time-wasting for members.
  • Employers are paying for coverage for employees who have long ago jumped ship, when termination is not done properly. And new employees may resent their employer when their benefits experience is rife with coverage issues.
  • Brokers and consultants are often responsible for ensuring coverage is intact. They also may be the ones charged with entering enrollment data into a broker portal or enrollment platform. So when there’s a data issue, they often bear the brunt of the blame. Aside from fielding calls from irate HR managers, brokers often take home lower commissions when enrollments are incomplete owing to data issues.
  • Carriers have been forced to set up costly systems and processes—such as large customer service operations—to deal with the consequences of poor data quality. Bad data can also mean significant premium leakage. And importantly, while many look to insurers to solve all data problems, it’s impossible for them to do so without the help of all the other entities involved.

Bottom line: The industry’s “dirty data” problem is pervasive, with detrimental ripple effects at scale. Consider: In our estimation, nearly 9 million employees in the U.S. could have a coverage issue.

What’s being done? Not enough. Many constituencies in the industry see data issues as unavoidable and insurmountable, resigning themselves to addressing the symptoms, not the disease.

We get it: These issues are daunting. They’ve been institutionalized to a startling degree. But with industry-wide collaboration, they’re also eminently solvable.

At Ideon, we have some thoughts on how this can be done. You can learn more about them here.

Bad employee benefit data has been institutionalized. We believe that’s a solvable problem.

Posted on by Dan Langevin

Up to 9 million employees may have a coverage issue

Over the past two years, as we have scaled our enrollment and member-management solution, we’ve been surprised less by the data problems we have seen than by the resignation among various constituencies that such problems are inevitable and unsolvable. As an industry, we’ve institutionalized issues that undermine the protection of covered members, not to mention the great experiences that we’ve become accustomed to in other industries.

The data problems we see include incorrect identifiers (e.g. Social Security numbers), birth dates, effective dates, classes, divisions, addresses, phone numbers and more. Some of these are less critical than others, but many create coverage issues. 

How broad are these issues? Overall, we see existing problems with approximately 10% of subscribers we migrate on to the Ideon middleware platform. Importantly, we regularly see coverage issues with 8% of the lives we migrate onto the Ideon platform. The members in this 8% are either missing coverage for which they enrolled, or are still enrolled when they should have been “termed.”  Fifty-six percent of all groups we migrate on to Ideon have pre-existing, critical (coverage) errors. And substantially all large groups have such errors.

To put this into perspective: 110 million employees in the U.S. have employer sponsored health insurance and employee benefits. So if our experience holds true to the broader base, almost 9 million employees could have a coverage issue. Are we surprised? Doesn’t matter. What’s more important is that we pull on this thread to see the impacts across our ecosystem.

Let’s start with the employee, or member. Stories of arriving at the doctor only to find the coverage for yourself, or your child, is not in place are rampant. Although bad enough, this can be solved (albeit retroactively). But what about someone who dies and wasn’t properly enrolled in life insurance? Imagine the impact on the family. These are not trivial issues.

So now let’s look to the employer. Both sides of the coverage coin adversely affect the employer. If an employee is not properly terminated, the employer will continue to pay for their  coverage. Worse are instances when an employee is not covered and should be. Nothing undermines employee benefits goodwill like coverage issues. Imagine a new employee whose spouse visits the doctor with a sick child only to discover the child is not covered. 

Brokers and consultants are likewise not immune from the impact of coverage issues. Their responsibility often extends to open enrollment and making sure coverage is correct. This is exacerbated when they are the ones actually responsible for entering enrollment data into a broker portal or enrollment platform. The broker/consultant is often the first call from an angry HR manager. At the same time, incomplete enrollments may mean lower commissions. In a recent migration of one BenAdmin we found data issues preventing coverage that aggregated  more than $1 million in premium. While certainly not all with one broker, commissions on this business were absent because of these data issues.

Which brings us to the carrier. Many put the onus on insurers to fix all issues, but they simply cannot do so without the help and cooperation of all the above entities. Unfortunately, and in the absence of solving the problem, carriers have been forced to allocate substantial resources, and develop systems and processes (think member operations and customer support), to deal with the symptoms of these issues: the unhappy member, employer and/or brokers. And as noted above, the premium leakage affecting the carriers can be substantial.

The frustrating aspect of all of this is that these problems are solvable—but it takes a village.

A role for every stakeholder

Fixing our industry’s data problems will require contribution from many stakeholders. No single party can solve these issues alone. The good news is that the benefits of resolving these issues accrue to all. 

Carriers: The most important step toward resolving these issues and keeping the data clean over time is for carriers to expose group structures and censuses through some kind of repeatable digital process. With this data, the same data from the employer, through their BenAdmin, can be compared and differences surfaced. Today, very few carriers make it easy to access these data on a regular basis. This is one reason we at Ideon have written that the most important API a carrier should develop is a census API.

Middleware: The role of middleware encompasses far more than connecting carriers, BenAdmins, and other industry participants. Middleware, such as Ideon, also plays a key role in cleaning up data discrepancies and keeping employee benefit data accurate. Middleware’s role is to 1) identify discrepancies between the various parties; and 2) normalize, structure, and deliver those errors to the appropriate party to adjudicate. While the first role is obvious, the second is less so. The reality today is that each carrier describes, and delivers, the same error differently. Some may use plain language “the social security number is invalid” while others may use a code to describe that error. Many of these errors are sent by email, while some carriers send these errors in files, and a very few through APIs.

Middleware’s role of normalizing and structuring this data is critical to delivering great experiences for all of the parties who ultimately need to fix the errors. If brokers, employers and members need to parse through emails and files for errors from different carriers and/or interpret what the error is, we will never create an environment conducive to fixing these problems and keeping them fixed.

The industry-changing potential of middleware was evident in one recent migration of about 200,000 employees onto the Ideon platform, all enrolled with a large national carrier. During that migration, our technology identified errors impacting more than 16% of the employees, resulting in nearly $1 million in lost premium for the carrier—and, we expect, lost broker commissions.

In summary: we found $1 million in additional premium for the carrier, and we saved more than 30K employees from potential coverage issues. All from one migration of approximately 200,000 employees. Projected across the industry, we can safely assume carriers are leaving tens, if not hundreds of millions of dollars on the table.

BenAdmins: BenAdmins play a critical role in creating a path for these errors to be addressed. While we, as middleware, can surface these problems, we cannot adjudicate many of them. As such, BenAdmins need to build into their solutions a means of directing each error to the appropriate party. A demographic error can be sent directly to the employee. But class, division and other such errors need to be addressed by the employer. Still other information may need the broker or consultant to weigh in. 

Ideon triages, classifies, and structures these errors allowing for easy and repeatable direction of errors to the responsible party.

Brokers: For some employers, especially smaller companies who may not be using a benefit administration system, the responsibility for fixing the errors falls on the broker. Once surfaced, brokers have a responsibility to fix the data discrepancies. At first this can be daunting when confronted with the sheer number of problems that need to be addressed. This is especially true as we all set on a path to clean up pre-existing problems. Fixing Social Security numbers, birth dates, effective dates and the like is self-evident.  But some may be inclined to dismiss errors in addresses, or such demographic data. But ultimately a great member experience relies on these data being right. Whether it is for receipt of plan materials, or a claim check, this often-ignored data is critical.

The good news is that once the heavy lift of cleaning-up existing problems is complete, very little ongoing work by the broker should be required to keep the data clean.

Employers: Employers too have a role to play. It is incumbent upon the employer to make sure enrollment and effective dates are corrected and to address any inconsistencies around an employee’s classification including assignments to certain divisions, departments etc.

The first step: A shift in mindset

If the above framework feels daunting — I get it. Fixing a deeply embedded, decades-long problem is always challenging, made more difficult in a complex industry with numerous stakeholders and competing priorities. But we must start somewhere.

As a starting point, I hope to see the industry to coalesce around—and be inspired by—these three convictions:

1) It’s a problem worth fixing.
2) It’s solvable.
3) It requires industry-wide collaboration.

If we as an industry can shift our mindset and unite behind these three beliefs, we’ll be on our way to eliminating inaccurate benefit data—and its harmful impact.