Looking Back and Going Forward

As we look back at 2020 from a business perspective, it’s almost mind-numbing to summarize the meaningful events that unfolded. Ultimately, I’m so proud that we accomplished our greatest period of organizational growth and refinement over the last six months despite all the noise and uncertainty. The idea of sharing my feelings externally was met with some internal pushback, “talking about improvement could lead people to negative conclusions.” I completely disagree with that sentiment and believe any organization that isn’t continually challenging itself to improve is failing or declining.  It’s essential for reference-based pricing (RBP) companies to be focused on serving their distribution partners and evolving with the changing landscape of healthcare.

While we witness our industry competitors chase money, revenue, and investor satisfaction over broker, client, and member satisfaction, we remain focused on our mission to deliver the most comprehensive RBP solution in the market at the lowest fee structure possible. Our comprehensive solution is designed to give members the best possible experience while managing both the medical plan’s expenses and liabilities. Feedback from brokers continues to be that our program gives them the best opportunity for successful delivery and RBP client retention.

I’m sure some of the PEPM (Per Employee Per Month) lovers out there are groaning about our fee structure. We are not all things to all people. That is fine if clients want savings and are willing to sacrifice member experience and take on unknown future litigation risks. The interesting part to me has always been wondering if those clients ever receive a cost-benefit analysis regarding their decision. Underwriters tell us that even with higher fees supporting our service model, our willingness to stand behind our audit nets more significant savings after the PEPM players follow their playbook on settling claims. This is probably the most I’ve engaged on the topic and have typically chalked it up to differences in beliefs, and it’s ok for you to be wrong. In all seriousness, I would love for consultants to learn more about our blended rate instead of just seeing the 10% of billed charges that pops up on spreadsheets. Consultants need to understand the impact of rate caps, charging 6% on contracted claims, and repricing professional claims under $2,000 for free. Last year, our blended rate across our book was 7%, and I’d be surprised if it doesn’t drop in 2020 due to ongoing contracting efforts. Consider the additional services received versus a PEPM. For those using the dinosaur that won’t put in caps and won’t charge less than 12%…..I hope one of our brokers talks to your client soon.

What am I most proud of this year:

  • Our employees. Working from home and some transitioning back into the office when asked to do so safely. Whatever the situation, they didn’t skip a beat. Special shout out to our Member Advocates. I was finally added to the email that circulates when they get compliments. It’s amazing, and I love the work they do. A “wise” operator in the industry once told me that it was great our team cared so much when they were small, but that will never last. Our member advocates proved him wrong.
  • The new sales team. What a great group who bought into our differentiators and quickly became gut hooked on our mission. Yes, they want to make a lot of money, however, they understand it’s not about selling to everyone, it’s about doing business with the right people. I learn from them all the time, and they have made me better, I hope you are engaging with them:
    • Eric Meyerhoff (former Elap) – New York, South Jersey, Pennsylvania
    • Mark Nickerson (former UHC) – Georgia, Carolinas
    • Andrew Soha (former USI) – Florida, East Coast
    • Patrick Martel (former HST) – Texas
    • Omar Arif (former Imaginary Health/Elap) – Midwest, Mountain Region, Southern California
    • Andy Orear (former Reliance Standard) – Northern California, Oregon, Washington
  • Finally, the one I am most proud of, one of our terrific clients shared their employee survey results. The results showed 75% of their employees stated they would recommend their health plan to friends and family. They have an amazingly dialed in Human Resources Team that works with the industry’s best account manager, our very own Steph Mohr. Collectively, with the clients’ leadership, we are staying flexible and responsive to meet the needs of members and accomplish a level of service delivery that sometimes surprises me.

What’s coming next year? We keep getting better, and we do a better job of telling people how good we are.