Commentary: Three lessons for health plans from 25 years of experience

Health care is facing perhaps the greatest level of complexity in the history of the industry.  The rise of consumerism, regulatory interventions, and technology applications create pressures from all sides for an organization trying to bring coherency and coordination to the point of patient care.

It’s not easy.

Moreover, many of the institutions in health care are built around legacy models of doing business that aren’t readily compatible with the challenges of today.  Whether that is a hospital, a health plan, or a broker-led association, sometimes health care institutions are less agile than today’s market demands.

For example, if you’re a commercial health plan, you know that you have to continue to drive administrative simplicity to your clients, both for ease of use and to bend cost trends downward.  At the same time, you must provide new services, processes, and benefits to meet the changing demands of consumers, particularly millennials or those with multiple chronic conditions.

It’s this space – between the legacy model of health plan services and the changing needs of the group and association markets – where Vimly Benefit Solutions rests.

Vimly is a benefits administration technology and service provider that has spent 25 years working to bridge this gap.  Our experience helping commercial carriers and association health plans is steeped in determining what works and what doesn’t, what solves problems versus what creates them.

In other words, we bring the kind of agility and creativity in problem solving that is sometimes missing in health care today.

From decades of delivering solutions for health plans, and looking forward to the challenges of providing coverage to beneficiaries in 2018, we think there are three key lessons for health plans looking to the future.

  • Servicing evolving client needs will require greater billing simplicity, more transparency in pricing, and a better use of a technology that eases rather than complicates interaction. These trends are building rather than slowing. As an industry, successful plans are working to address these issues more rapidly than they ever have.  We are helping plans in six states deliver a more unified, simplified administrative interaction with their members and employer-clients so that the conversation between the plan and the beneficiary is about patient care rather than administrative headaches.  As a result of this experience across multiple markets and use cases, we can rapidly assess issues and deliver agile technology and services at the speed the market demands.
  • Increasing administrative complexity and spiking premium increases threaten strong margins in the small group market. The small group market continues to be one of the higher margin lines of business for insurance companies nationwide.  It is also a business that can be difficult to manage, requires collaboration from producers, and resists efforts at coordination.  In many regions, like the Pacific Northwest, the market continues to demand provider choice as well as downward cost pressure on premiums. That’s a difficult problem to address in a legacy PPO model.  Our experience with working with health plans demonstrates that the range of creativity is narrowing, making the effective implementation of innovation administrative models all the more important.
  • Association health plans (AHPs) may get re-invigorated under President Trump’s executive order. However, these won’t be the same AHPs from the pre-ACA era. There is new enthusiasm for association health plans, and for good reason.  But the ease with which pre-ACA AHPs could generate margins for associations is long gone.  The regulatory complexity, the administrative challenges of new benefits, and the risk modeling for the small group space are all much different than a decade ago.  Successful AHPs are now looking to incorporate technology tools, options among available products, and new services like expanded substance abuse and behavioral health benefits.  Our experience has taught us these needs are often always customized, and never “off the shelf.”  Each association’s approach is different, reflecting the often unique diversity of their members.

Health care will continue to be complicated.  Wisdom gleaned from 25 years of successes with health plans has taught us that with agility, innovation, and customization we can navigate that complexity together.

Shannon Jurdana is President and CEO of Vimly Benefit Solutions, a privately-held company in the Seattle area. Established in 1993, their business model is built around a single mission: to create technology and services that simplify the complexities of workforce and benefit administration.