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Topic: InsurTechs

Build vs. Buy: The Case for Enhancing Carrier Connectivity to Improve Enrollment Experiences

Posted on by Zach Wallens
By Zach Wallens, Communications Manager at Ideon

One-stop-shop HR and benefits administration (BenAdmin) platforms, which integrate all elements of the employee experience into a centralized system, are the future of the benefits industry. From health insurance and dental coverage to telehealth and gym memberships, those BenAdmins that offer the most-popular employee benefits on one platform will boast the best user experience and, as a result, a significant advantage over rivals. In fact, some forward-thinking BenAdmins are already preparing for this all-in-one future, laying a foundation to scale aggressively and add new benefits at a moment’s notice.

But this trend raises an important question: How, from a technical standpoint, will BenAdmins add all of these benefits products—from numerous insurance carriers and other providers—to their platforms?

The answer, as most BenAdmin executives know, is digital connectivity. BenAdmin platforms have long identified connectivity with carriers as a technological necessity—and competitive differentiator—for success in today’s digital-first age. Connectivity enables BenAdmins to present up-to-date product information, enroll employees in benefits digitally, and transfer group and employee-specific information to carriers and other providers. It is a pivotal component of any modern BenAdmin experience.

But while digital connectivity is universally accepted as integral to any tech-forward BenAdmin’s UX strategy, a consensus has yet to develop on the issue of building or buying a solution for developing and maintaining carrier connections. Many BenAdmins elected to utilize their existing technology team to build integrations to carrier systems because this was, until recently, their only option.

This go-it-alone “build” approach, however, has been technically and operationally challenging for BenAdmins. Establishing and sustaining relationships with hundreds of carriers and providers—each with unique systems and formats to which BenAdmins have had to conform—is a process that is both time-consuming and labor-intensive. Moreover, integrating to each carrier’s core systems, one by one, involves tremendous development resources.

These drawbacks are prompting many BenAdmins to consider a new digital connectivity strategy: the “buy” approach. Indeed, a growing number have determined that buying connectivity on a mass scale, through a carrier connectivity partner such as Ideon, is a more effective use of resources than building those bridges themselves.

In this scenario, BenAdmins integrate with a single partner’s API, and it’s that partner’s responsibility to manage the connections and exchange of data—often in real time—with carriers and benefit providers.

These BenAdmins are outsourcing carrier connectivity to specialists in just that skill, resulting in massive efficiency gains, a quicker path to scalability, and better experiences for end users—employers, HR teams, and employees. Such forward-thinking benefits platforms have decided that it makes more business sense to invest in a turnkey solution that is built, managed and regularly improved by industry-specific digital connectivity experts than to devote time, money and labor to create multiple carrier integrations themselves.

Instead, these BenAdmins are taking the savings achieved from outsourcing connectivity and investing them in the development of improved experiences for their customers’ employees. Data-driven plan selection, personalized decision support, integrated telehealth services, and robust ancillary offerings are just a few of the tech-enabled experiences that employees expect from their BenAdmin. These are features that require ongoing iteration and improvement, and represent far better destinations for operational capital.

Buying is the new frontier of BenAdmin-to-Carrier connectivity, a forward-facing reallocation of resources that goes a long way towards enhancing their competitive advantage.

Arguing API vs EDI is Missing the Point

Posted on by Dan Langevin
By Dan Langevin, Ideon co-founder and CTO

The evidence is in: APIs are the future. Across industries—in travel, healthcare, retail, marketing, hospitality, etc.—Application Programming Interfaces are the superior technology for real-time data exchange in complex digital ecosystems.  

That’s no less the case in health insurance and employee benefits, industries for which it is essential that carriers, brokers, employers, and InsurTech companies be able to exchange accurate and up-to-date information that provides members (not to mention those brokers and employers) with the seamless digital experiences they’ve come to expect.

In fact, carrier executives today recognize that they must develop and deploy APIs for enrollment and eligibility or risk being left behind. 

But if APIs are the future, the present is still dominated by EDI—Electronic Data Interchange—and migrating to the former from the latter will take many years and untold millions of dollars. Recognizing this, some carriers are trying to bolt an API onto their existing legacy technology. But this process can also take several years and cost millions of dollars—and still may not provide InsurTech platforms what they need most: real-time access to carrier systems with dependable data quality.

Missing in too many calculations around this issue is the fact that there’s a way to achieve API-like, near real-time synchrony and high data quality today, through EDI: Ideon’s infrastructure solution, which puts an API “wrapper” around EDI. This hybrid approach allows carriers to save money and deliver higher quality service to brokers, employers and plan participants now—and build APIs when they are ready.

To understand why a hybrid approach that incorporates EDI and APIs is best, for now, it helps to recall the evolution of the technologies that carriers deployed to manage members.

In the 1990s, the industry began to adopt an electronic method for brokers and employers to submit enrollment data through BenAdmins to carriers: EDI. But if EDI is a fine format for eligibility and demographic information, it is limited. In particular, EDI is asynchronous—i.e., a one-way transfer of information—so errors aren’t detected until after the file is submitted and an exception report is returned to the sender. 

Moreover, the way the industry implemented EDI created as many problems as it solved. Each carrier developed its own EDI variant, requiring extra work from any broker, employer or technology company that needs to communicate with multiple carriers. Each carrier also has its own internal system for associating participants with plans, rates, networks and other details. These labels often don’t correspond to the way employers name plan options and describe them to workers, so the carriers needed another army, analysts, to clean up the data.

This resulted in two nettlesome consequences. First, because it takes time to review these EDI files, carriers limited how frequently they would accept them (generally, no more often than weekly). This gave rise to a two-week (or more) round trip, which contributed to poor experiences for employers, employees and brokers. For example, while an employee could use an HR app to, say, add a newborn dependent, they’d still have to wait two weeks for confirmation that the change was made correctly.

The second unfortunate consequence was that many carriers chose not to use EDI for small groups because they didn’t want costly analysts working on less significant accounts. So, for smaller groups, carriers asked brokers to enter enrollment data through broker portals. But if this sometimes reduced operating costs, it was—and is still—prone to errors.

Small wonder, then, that modern InsurTechs would prefer carriers to adopt APIs, which are, after all, how computer systems built this century communicate: Their developers know how to use APIs, and have myriad tools to speed their deployment and maintain security. For the BenAdmins, two aspects of APIs are critical:

  1. Bidirectional, transactional connections. That is, real-time conversations vs. the one-way lagged transfers of information of EDI. This  means that when an employee inputs a new baby through an InsurTech app, the API will transmit the name, birthdate and other information and receive near-immediate confirmation that the dependent has been added to the policy.
  2. Higher data quality. The real-time data exchange of APIs enables errors to be identified and addressed quickly. For example, if the new parent mistypes a social security number, the carrier API will flag the error immediately, allowing the employee to correct the information. 

So, of course, carriers should move from EDI to APIs … when they are ready. 

The problem is that they cannot do it as quickly or effectively as some in our business would imagine. A new API, by itself, won’t speed up the rest of the carriers’ electronic workflow. Their core systems still rely on mainframe technology that updates overnight and can’t support real-time changes. And there is a lot of hard work to do to automate the cleanup of enrollment data and the assigning of accurate product codes.

What’s more, APIs typically take years to develop at costs rising into the millions … and the carriers have to do all this with IT budgets already stretched just keeping up with ever-increasing regulatory demands. It’s why we’re in this situation: There has always been a more pressing issue than building eligibility APIs or replacing core systems. 

Still, brokers, employers and members expect fast, accurate and convenient access to all their coverage information. Which means that carriers disappoint them at their own peril. So what’s the industry to do? 

Embrace middleware, which solves all of the above problems and gives carriers the time they need to transition to APIs fully and most advantageously. At Ideon, we start with the premise that not only can we work with the EDI systems that carriers have, now and as they evolve, but elevate those systems to the benefit of both InsurTechs and carriers. By doing so, we give BenAdmin and other InsurTech companies the APIs they yearn for, and the carriers the clean data they need. Importantly, these APIs are consistent across carriers and lines of coverage for the functions we enable. This imparts significant leverage to these technology companies.  

How do we elevate EDI?  We build into these APIs each carrier’s business rules and validations. That enables synchronous responses to errors that may exist in their submission; errors that would have otherwise been transmitted to the carrier and taken a week to come back to them through a traditional EDI connection. These validations ensure that the EDI files we send to the carrier have fewer errors. As they spend less money to clean up EDI data, carriers become willing to accept EDI files more frequently (sometimes daily) and from smaller groups.

We also facilitate the exchange of data back from non-API carriers. For example, we ingest group structures and censuses from carriers regardless of how they are able to deliver these data (e.g., files, email, API, etc). Then we normalize this data, structuring and delivering it through an API to our InsurTech partners. Such data is used for group installation and reconciliation. This functionality eliminates what has historically been another set of manual tasks.

Taken together, our hybrid approach delivers 80% of what a true end-to-end API-to-API solution would. Again, we are not arguing against carriers building APIs. Quite the opposite. In fact, we are often asked to be thought partners as to the sequencing and structure of those APIs, and happily so. But we are saying that middleware is a solution that works very well today, leveraging EDI while addressing most of its shortcomings, thus allowing carriers room to develop APIs when they are ready.

And for those who doubt that middleware that incorporates legacy EDI technology can support modern BenAdmin systems, we offer this quick review:

  • Connected, virtually real-time experiences: ✅
  • Data quality: ✅ 
  • Leveraging existing technology and infrastructure: ✅

Over the coming months we will talk more about  a number of the areas touched on above. In the meantime, if you’re interested in our approach to simplifying the exchange of health insurance and employee benefits data, reach out to sales@ideonapi.com

Opportunity Awaits BenAdmins that support ICHRAs

Posted on by Ideon

By now, Individual Coverage Health Reimbursement Arrangements (ICHRAs) are no secret. Emerging only two years ago as an obscure addition to federal health insurance regulation, ICHRAs are now among the hottest topics in employer-sponsored benefits. But any significant employer shift to ICHRAs will require answer to a pair of important questions:

  • Is there an ICHRA role for benefits administration (BenAdmin) platforms?
  • If so, what exactly is it?

We can begin to answer both by examining the motivation for companies large and small  to migrate to ICHRAs. For small companies, ICHRAs are often a way to do something as an alternative to not offering employer sponsored health insurance. In fact, 70% of the small employers (<50 employees) offering an ICHRA today are contributing to their employees’ health insurance for the first time, according to Take Command Health. ICHRAs also allow small employers to get out of the often-burdensome benefits administration business. So, at the end of the day, there may be very little opportunity for BenAdmins in ICHRA-based small employers. 

Large employers, however, are another thing.

There are several reasons why large employers might adopt ICHRAs—but getting out of the benefits administration business is not one of them. First, a feature of ICHRAs is that they allow employers to move classes of employees to ICHRAs while keeping others on their existing group health plans. This provides more choice—and therefore a better benefit experience—to certain classes of employees. The last thing such employers want is to undermine a better insurance experience with a lesser benefits administration experience. These employers will very much want their BenAdmins to support individual and group products.

A second reason large employers that adopt ICHRAs will not move away from BenAdmins is that they want to keep certain products (e.g., group life and disability) on the group “chassis.” This, too, requires BenAdmins to support both individual and group products.

All of which suggests a three-point game plan for BenAdmins to remain competitive in an ICHRA world:

  1. Support both individual- and group-plan comparison. BenAdmins must be able to support a hybrid individual and group plan comparison experience. For instance: group health and ancillary for some employees but individual health and group ancillary for other employees. And unlike the group market, where a typical employee may choose from a handful of medical plans that are fairly easily configurable, tens (if not hundreds) of plans may be available and will therefore need to be configured.  
  2. Support both individual- and group-plan decision support. Accounting for tens (or hundreds) of medical plans exacerbates the complexity of plan choice by each employee. So BenAdmins must shepherd employees through the decision process with the appropriate tools and features. What was once optional (shop-by-doc, shop-by-drug) is now table stakes. 
  3. Support both individual- and group-enrollment and eligibility changes. Only offering plan selection during open-enrollment period (OEP) is not enough. BenAdmins will need to support individual enrollment, demographic changes, QLEs, etc. for individual products. This represents a whole new integration challenge for BenAdmins.

Bottom line: ICHRAs are an opportunity

ICHRAs do not spell the end of benefit administration— at least not with larger employers. But BenAdmins will need to enhance their platforms to support this new and important coverage option. And in doing so, they will set themselves apart from competitors who disregard a coverage option that could become as ubiquitous as 401(k)s.

If you’re interested in reading more of Ideon’s 2021 ICHRA research and learning how APIs can streamline the development of ICHRA solutions, download our full-length ICHRA toolkit.

The Future of Benefits Administration Platforms: Centralizing the Employee Experience

Posted on by Ideon

Basic health insurance ✅
401(k) ✅
Paid time off ✅

Employee benefits, once mostly a collection of must-check boxes, have transformed into multifaceted rewards programs, customizable to meet the needs of each employee and a key differentiator in recruitment and retention. Ancillary benefits such as pet insurance, gym memberships, and financial assistance programs are becoming the norm, fueling higher expectations for what employees receive, beyond compensation, from their employers. The enhancement and personalization of employee benefits, however, has caused a ripple effect throughout the world of benefits administration (BenAdmin) platforms.

The ways in which BenAdmins have adapted to this new dynamic offer a predictive glimpse into the future of this crucial sector. Just the basics—health insurance enrollment, management of paid time off (PTO), etc.—will no longer cut it. Instead, forward-thinking BenAdmins are preparing for the future: all-in-one platforms that integrate all elements of the employee experience into a centralized system.

From payroll, dental insurance and 401(k)s to FSAs, wellness programs, retirement plans, stock options and student loan repayment, BenAdmins of the future will consolidate all relevant information within one central platform. Those who succeed will not only be incredibly agile—easily adding the hottest non-core benefits of the day—they will be perceived as incredibly agile, representing a major differentiator. They will possess personalized data and insights to share with employees so they can make more-informed decisions about health and benefits products. 

So what is the future of benefits administration? In a word, unified. A single system to rule them all. No employee—and, for that matter, no broker or employer—wants one system of record for health insurance, another to manage stock options, and still another to review HSA balances and employee assistance programs (EAP).

Although tying all of these components together into a single platform will become an essential differentiator between BenAdmins, certain features are gaining in popularity and will ultimately be expected by employees. Here are three trending features that will be an important part of all future BenAdmin platforms:

  • Healthcare concierge services help employees navigate the complexities of our healthcare system, from recommending providers and facilities based on quality and cost, to minimizing healthcare spend by redirecting employees to, for example, an in-network urgent care facility. 
  • BenAdmins of the future must consider employee wellness a vital piece of the benefits package. Mental health assistance, financial wellness programs, and telehealth services should be easily accessible and integrated into the centralized employee experience.
  • Personalized ancillary benefits provide employees with the opportunity to select the non-core benefits that best fit their needs and interests. Some might prefer a gym membership and pet insurance to an HSA, and others may deem student loan assistance a prerequisite for any job offer. More choices, more benefits, more customization—that’s a key pillar of the future of benefits administration.

The future of benefits administration is truly limitless, but it can only reach its unified, all-in-one potential if, on the back-end, BenAdmins have agility and connectivity. Agility because, inevitably, new benefits options—perhaps even entirely new benefits categories—will become popular as younger employees enter the workforce and expect benefits packages to align with their interests. To remain competitive, BenAdmins will need a scalable method to integrate these benefits quickly and efficiently.

Connectivity enables BenAdmins to exchange group and employee-level data with carriers and other benefits providers, such as telehealth, gyms and wellness companies. BenAdmin connectivity is the first step in bringing the full employee benefits experience onto one platform, allowing employees to enroll in and manage benefits across a variety of carriers, lines of coverage, and products. Historically, carrier and benefit provider connectivity has been technically and operationally challenging for BenAdmins. But today, APIs offer BenAdmins a lifeline to simplified, flexible and scalable connectivity with multiple parties.

To learn more about how APIs can streamline connectivity in the benefits ecosystem and prepare BenAdmin platforms for the future, contact Ideon for a consultation.

Lightening up the year-end blackout period for employee benefits

Posted on by Dan Langevin

Ideon ends the hassle of changing current-year plan details during open enrollment.


By Dan Langevin, co-founder and chief technology officer of Ideon

Towards the end of every fall, as 1/1 renewal dates loom, insurance carriers, brokers and members work diligently to ensure that upcoming plan elections go off without a hitch. Meanwhile, life goes on in the current plan year, and life events that affect enrollment need to be addressed. Simultaneously managing the current plan year changes and the upcoming elections is often a tricky ordeal.

The fact is, most carrier systems struggle to manage coverage across plan years—regardless of the carrier’s backend data ingestion system (EDI 834, API or a custom format). When you consider that enrollment elections for the next plan year begin at least a month before the effective date and that changes can continue to be made retroactively for 60 days, cross-plan-year changes can actually be a problem for three months a year.

To this point, the “state of the art” solution has been manual one-off processes. Carriers require specialized, custom formats (different from their regular EDI 834, API requests or flat files) or specially timed delivery of changes for the prior plan year that differs from the regular file delivery day. In practice, most brokers and operations teams at BenAdmin platforms handle these changes manually, by contacting the carrier or by entering the data into the carrier’s portal. This isn’t exactly ideal. Nor is it ideal for the carriers, as their cost-saving automation is bogged down by so many extra manual touches.

This is a major systemic shortcoming. How can we realize full digital connectivity if for 25% of the year we require a separate manual process to handle basic changes?

Eventually, the underlying limitation will be resolved. Carriers will upgrade their internal systems, data models and processes to seamlessly handle cross-plan-year changes. But, as with many things technology-related at large national carriers, the investment required to accomplish that will be large and the timeline long. The market wants a solution today.

Enter Ideon’s Blackout Period Change Management. We have worked diligently with our carrier partners to develop cross-plan-year, change-management processes that eliminate the need for one-off manual changes. The result: the effective elimination of Blackout Periods.

From the BenTech platform or broker’s perspective, data is sent to Ideon’s APIs per standard operating procedure. Our data model has the concept of different plan years baked in. The differences between how transactions are handled with each carrier are entirely transparent. It “just works.”

From the carrier’s perspective, cross-plan-year changes remain less than ideal. Most carriers need to do some level of system acrobatics to process them. That can mean tasks as manual as employees processing a custom Excel doc with every requested change. That said, knowing that they are getting clean data in a consistent format from multiple BenTech platforms gives them back some of the leverage they reap from automation the other nine months of the year. Further, as the carrier upgrades the efficiency of their internal systems (to standard file feeds or, ultimately, to APIs), it will have a partner who understands the idiosyncrasies of cross-plan-year changes and can help to develop a technical integration and business process.

This fall, we piloted our Blackout Period Change Management process with a large customer that covered tens of thousands of lives across hundreds of groups and four carrier partners. The feedback from all sides was extremely positive. That success has made us that much more excited for a broad rollout across all of our carrier and BenTech partners.

Ideon’s mission is to make insurance and employee-benefit data flow freely between member-facing tech platforms and insurance companies. We know that APIs will be a big part of that solution. In the short term, though, we will also provide innovative, tech-enabled business processes that bridge the gap between where we think we should be and the realities of what exists in the ecosystem today. 

Contact us to learn more!

Covid is forcing a reckoning for the health insurance industry—and that’s good

Posted on by Dan Langevin

By Michael Levin
Co-founder and CEO, Ideon

The Covid-19 pandemic is a once-in-a-lifetime stress test of the healthcare system. And while most of the attention has rightly been focused on front-line healthcare delivery, the provision of employer-sponsored health insurance has also been substantially disrupted. Those carriers, brokers, and employers who respond with speed, creativity and flexibility will emerge from this crisis with more modern, efficient, and resilient systems than ever before. Those who don’t, I believe, will regret their failure to seize the moment.

Until Covid, a great deal of the health insurance sales cycle has involved face-to-face contact. Brokers met with employers, often using paper presentations to compare various options. Then, in open enrollment, many employees would explore their options by meeting in a cafeteria or conference room with carrier or broker reps. A lot of administrative details were still processed through paper forms.

Today, much of this interaction has gone digital, via video calls, webinars, micro sites, and apps. For some clients, this forced transition has meant a loss of intimacy and trust. But in general, those people who had been reluctant technology users have discovered the speed and convenience of online interaction. 

At the same time, the pandemic has spurred some in the industry to modernize anachronistic practices. For example, some carriers have scrambled to figure out how to accept credit cards, as some business clients were no longer working in offices where they could easily cut checks.

We can expect a good deal of this behavior to continue and even expand after the pandemic subsides, further reducing costs and improving service quality throughout the industry. 

But there are also more subtle changes that accompany these shifts from in-person to online interaction. To serve employers remotely, brokers are now providing access to online marketplace tools that allow such customers to compare plans  and rates  from multiple carriers. 

To be sure, many insurance companies have long been ambivalent about the rise of new technology-driven,  multi-carrier, distribution platforms. They would prefer to have direct interaction with brokers and clients, if not through their sales force than at least through proprietary online systems. Being just one item on a menu of carriers, they fear, neutralizes their differentiation, and focuses competition on price. Now, though, the market has been refocused by COVID, with brokers and employers alike demanding the transparency and efficiency of these platforms. As such, carriers are increasingly open to partnering with InsureTech companies.  

Carriers have faced similar choices about how to inform customers of expanding coverage for telemedicine and testing, relaxed policy rules, and other changes in response with Covid. Some have largely restricted this information to their own sites and apps, offering a rich stream of communication to the tiny fraction of their customers who use those channels. But others have partnered with brokers and technology companies to distribute their content—finding that what they lose in control is more than matched by gains in reach. 

This dilemma is neither new nor exclusive to the insurance industry. Airlines would rather sell tickets on their own sites than through Expedia. Banks would prefer you check your balance on their app, not Mint. But these companies have come to understand that they need to do business in the ways their customers want. 

The insurance industry must continue to absorb this lesson. And I believe it will. Indeed, if the new Covid vaccines are as effective as initial reports suggest, I suspect that a year from now we will start to see a significant restructuring of the health insurance industry. 

Because there’s no going back.

That is, a lot of customer behavior will already have permanently changed. Fewer people will work from offices, limiting the revival of face-to-face sales calls and common-area recruitment sessions. And many of even the most resistant to new technology will have learned to use digital tools for buying and managing their health insurance. Nobody will want to go back to filling out paper forms.

Most significantly, employers and plan participants will think back and remember how well—or how poorly—they were treated by their insurance companies. 

Were they able to get information and handle transactions easily and efficiently? 

Which companies responded creatively and with flexibility to the rapidly changing world—and which were stuck in an irrelevant past?

It’s a stress test for the entire industry. Not all will pass, but those that do will ultimately be grateful for the reckoning brought on by an otherwise awful pandemic.

Vericred Launches Health Insurance Card Scanning API

Posted on by Ideon

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

 

Bridging the gap to in-network providers and facilities

NEW YORK–(BUSINESS WIRE)–Vericred, a data services company simplifying the exchange of health insurance and employee benefits data, today announced the availability of its Card Scanning API, enabling applications to programmatically identify a user’s provider-network from their insurance card.

This solution helps solve one of the toughest health insurance problems: most members don’t know their health insurance network. For those building applications with any kind of provider search or referral functionality, this seemingly simple problem has been a gating factor to a great user journey — and the right information.

“As fewer health insurance plans offer out-of-network benefits, and those costs have continued to soar, finding an in-network provider is more critical than ever. Yet most people simply don’t know their network, so finding an in-network provider is very challenging,” said Michael W. Levin, Vericred’s CEO. “By extracting the network ID from an image of a user’s insurance card, we enable digital health and insurance apps to easily surface in-network doctors, hospitals, and other facilities.”

The Card Scanning API empowers provider search and doctor appointment apps, benefits administration platforms and other digital health companies to develop seamless digital experiences connecting users to the in-network providers they need; easily and accurately.

Vericred’s new API is especially important in the age of COVID-19. With telehealth on the rise, when a physical visit to a doctor or hospital is warranted, it is essential that patients be referred to an in-network provider.

How the Card Scanning API works:

  1. End-user uploads an image of their health insurance card to a digital health app.
  2. The digital health app transmits the image to Vericred, via the Card Scanning API.
  3. Vericred’s API identifies and returns the user’s network ID.
  4. The application then uses the network ID to search for in-network providers and facilities.

In response to COVID-19, Vericred is offering the card scanning API, at no cost, to its partners through the end of 2020. Please contact Vericred if you are interested in learning more.

About Vericred

Vericred simplifies the exchange of data between carriers and technology companies that are transforming the way health insurance and employee benefits are quoted, sold, enrolled and managed. Vericred offers robust solutions for technology platforms and carriers focused on the employer market, as well as the under 65 individual, Medicaid and Medicare markets.