by Shawn Jenkins
Co-founder and CEO
Benefitfocus
Imagine you are an HR manager for an 18,000-employee company with facilities in eight states. Your HR and benefit offerings are complex encompassing payroll, 401(k), three PPO plans, two HMOs, wellness and disease management programs, life and ADD, and more. You face administrative challenges while your employees sometimes feel confused and overwhelmed with all their benefits. Considering the critical role you serve as the gatekeeper for your members’ health and wealth, why aren’t there solutions to consolidate and organize benefits communications?
It has long been the dream of health plans and HR managers alike to have portal technology that integrates all aspects of the HR and benefits function. A members communication platform to simplify not only HR managers’ lives, but those of all employees. Technical hurdles, security and prohibitive costs have, up to now, prevented such a solution. But a new wave of Web-based technologies is making this a viable and affordable option for companies of all sizes.
Progressive health plans recognize the importance of looking at the benefits universe as an interconnected community serving employees, helping to drive a healthy and productive workforce. The challenge in creating a member communication portal is breaking down the siloed, point-to-point relationships and tying together different players in the system, be they payroll, health and life insurers, financial services companies and other third parties.
For the health plan and benefits administrator, the portal concept makes real a one-to-many approach. It leverages the power of employee self-service to free plans and HR managers of tactical tasks and enable them to bring their expertise to broader strategic issues while still maintaining control. Integration portals drive down costs and increase the ROI of benefits.
The portal solution enables health plans to respond to the growing consumerism trend. Consumer directed healthcare (CDH) is the biggest trend in healthcare in 30 years. Federal and state government, the private sector, and consumer advocacy groups are calling for greater healthcare transparency and cost control. For plans, CDH plans reduce premium rates and annual cost increases but are complex to design and administer. A member communication platform is the number one tool that enables health plans to successfully offer CDH plans.
The Blueprint for the Successful Member Communication Platform
The integrated member communication platform vision puts the HR manager at the center of benefits universe, with each HR function integrated in an automated portal that includes payroll, health benefits, COBRA, life insurance, wellness and education programs, personal health record (PHR), 401(k), flexible spending accounts, health savings accounts and employee policy and manual content.
Such a system enables the HR manager to enter data only once, and have it replicated into all necessary partner databases. This requires bi-directional communication with insurers, medical providers, payroll companies and financial institutions.
Illustration: Benefits of the member communication platform for health plans
In a truly integrated portal, the employee sees her health plan and other benefit providers as one entity. The benefits management portal stitches together health plans and banks to allow payment transactions, enrollment and services business processes, online account management, and decision support.
Consider this example of an integrated portal: An expectant mother, uncertain and nervous of her many health options, uses her health plan’s portal to give her the best information to make choices. Her integrated portal shows which insurance plan is best for her family’s care, the best local labor and delivery hospitals, pregnancy healthcare content and videos, quality comparisons of nearby pediatricians, and offers advice on financial planning and spending. Her health plan and doctor communicate electronically, thereby improving care while reducing costs.
A primary difficulty in creating this benefits management portal is that each product is administered by a separate business entity with only one part of the overall product picture. Members will need to track claims records, claims payments, deductibles, funding and expenditures, but no single party has a window through which to view all financial information in its entirety.
A number of key interfaces must integrate to provide a comprehensive platform: 1) enrollment, renewals and member maintenance; 2) personal health and wellness; 3) personal healthcare finance planning and management; 4) provider payment authorization and payment events. This integration gives a consolidated view across all benefit providers. The progressive plans are building on the administrative functions of the portal to include doctor and hospital comparison tools, quality data and educational healthcare content and videos.
The member portal should be intuitive to the member, including tools and resources that make the experience seamless. The health plan should create a community that adds value and motivates employees to visit the portal regularly, not just once a year. The ideal member communications portal should include:
· Custom Benefits Architect - Employees can build custom health plans based on specific needs, using surveys, plan comparisons and cost calculators to help make more informed decisions.
· Electronic Enrollment Center – Health, life and ADD, 401(k) enrollment, account access and management, and real-time health claims adjudication are central components for eEnrollment. EOB reconciliation and employee deductible status are useful features. Online provider payments and medical debit cards are also attractive offerings.
· Flexible Saving Account and Health Saving Account Resource Center – These new models of healthcare insurance require education via text and user-friendly video presentations. Comparison tools and account contribution and fee management should also be included.
· Personal Health Record/Planner - Empower members to take control of their healthcare with a PHR, to which doctors and the health plan can contribute data for a holistic view of care and costs.
· Doctor/Hospital Search and Comparison Tool and Quality Data - Web-based tools can compare doctors and hospitals on specific procedures, using quality data available from state and private sources. A drug comparison engine enables employees to compare costs for generics versus brand names.
· Provider Connections - Make doctor appointments, e-mail questions and check claims payments with your doctor's office.
· Health and Wellness Resource Center – Health risk assessments in tandem with a
clearinghouse of health and wellness resources, based on gold-standard medical data, enable employees to learn about their health, diet, exercise, smoking cessation and other preventative wellness practices. Receivable programs and gift cards that encourage enrollment should be considered.
· New Media Initiatives -- Social media, podcasts, healthcare interest group community blogs and daily cell phone video health and diet tips can deliver member-friendly content anywhere, anytime.
HR Administration - And finally, employee manual with company policies, vacation planner, etc. can be integrated into the portal.
Illustration: Integrated member communication platform
Member Portals in Action
Take for example Blue Cross Blue Shield of North Carolina (BCBSNC), who realized the value of the member communications portal in capturing more CDH payment flow, transaction fees and deeper customer relationships. BCBSNC understood that continued growth and success of the CDH program requires that all partners in the health care experience be well informed. BCBSNC created, in conjunction with Mellon Bank, a member communication portal for claims information and financial transactions. The portal provides a consolidated view for members who can pay their claims from the health savings accounts. The portal received rave reviews from employer and members alike. This is because BCBSNC has been able to simplify for its members the educational process of very complex funds.
Progressive health plans and employers are already benefiting from technology solutions that make this vision a reality. One such employer is Bon Secours Health System, a $2.7 billion health system with 18,000 employees in 41 facilities across eight states. Bon Secours offers multiple PPO and HMO options through three Blue Cross Blue Shield MCOs. Bon Secours faces considerable HR challenges with diverse employee demographics and a multitude of benefits vendors. Like most employers, they juggle the goals of providing superior health benefits and insurance premium cost containment.
Healthy and happy employees are key to Bon Secours success in the highly competitive healthcare industry. For Bon Secours and BCBS, access and transparency are key themes in their member portal. With this communication portal, Bon Secours employees become empowered and see increased value in their benefits. The health plans together with Bon Secours offer HRAs, wellness, education tools and videos, comparison tools, e-enrollment, health content and employee manual are all part of the portal.
The Bon Secours portal created a completely electronic environment, eliminating HR’s basic pain point of paper enrollment. The portal’s electronic enrollment delivers all the data to the health plans with no paper flow. The payroll system interfaces with other benefits, all accessible through the portal by a single sign-on from the employee. When an employee enrolls and goes on the portal, they can watch video explanations of benefit terms, payments, etc.
Equally important, the employee communication platform frees Bon Secours’ HR staff to focus on human capital management. Instead of being occupied with answering basic questions such co-pays, the HR staff works with employees providing value-added professional support.
With their employee portal, Bon Secours set the stage for community building between employees and their health plans , employees and providers, and employees with other individuals with similar wellness interests. Bon Secours offers incentives to employees through their TotalRewards@Work program, which is integrated into their employee communications portal. Many health plan member companies vary their premium contribution based on such factors as tobacco usage, participation in wellness programs, willingness to take a health risk assessment, and the results of those health risk assessments.
The integrated benefits management platform and its member portal counterpart have the potential to deliver better member service, smarter and cheaper healthcare, and lower costs. But only if the wealth of data held hostage in health plans, providers and other third parties are brought together. Hand-in-hand with information technology is a shift in mentality. Health plans are the foundation for employee health and wealth, the facilitator and gatekeeper whose guidance and empowerment of employees can help the bottom line. Health plans should look for solutions that address the approach discussed here.
About the Author
Shawn Jenkins is co-founder and CEO of Benefitfocus, the largest provider of benefits software in the country. Benefitfocus solutions are used more than by 120 insurance carriers, touching 50 million insured consumers. For more information, please visit www.benefitfocus.com.
