Welcome to the Party

Transparency legislation has created a new wave of data-driven companies, resources, and information that have stakeholders in the industry drooling over access to this once-secretive, coveted information. The conversations resulting from this information are exciting: employers, brokers, and healthcare providers alike are demanding change, identifying the need for fair and cost-based pricing, and discussing solutions to reach that end. Here at ClaimDOC, we are excited too, and we welcome you to the party.

Since its inception, ClaimDOC’s approach to the market has included a multi-factored approach ensuring we are meeting our fiduciary obligations of being true stewards of plan assets while still working with healthcare providers to ensure access to quality care. We have used hospital cost data to determine claims reimbursement; we have analyzed price information to ensure our clients are paying an appropriate amount, and we research alternative options to sharpen competition and increase choices to play a part in increasing the consumerism in patient care.  

The data that is recently exposed – excuse me, ‘disclosed’ –supports the story ClaimDOC has been preaching for years. We are seasoned experts in not just pointing to the information, but actually using this information to help our clients offer sustainable health benefits. 

Most employers (i.e., all but the very largest) will continue to lack the necessary market power to unilaterally use the data to initiate change and alter the carrier-based model. The balance of power remains unchanged and lies with the BUCAs. The BUCAs have had access to this information for years and have done nothing to decrease the cost of healthcare for their clients. It is a reminder: access to information does not automatically result in change. Employers must know what to do with the data and where to turn.  A lack of proper expertise and knowledge, along with the necessary mission to translate this data into effective action, will lead to a false sense of power and mismanagement. Direct contracting is a frequent, low-hanging fruit solution presented. However, knowing the when, where, and how to contract requires knowledge beyond the numbers. 

Long before the transparency data craze, ClaimDOC has been a steward of change and has been implementing the solutions that are now being described as tomorrow’s hope. These ideas are not new to us nor is the navigation and advocacy we provide on behalf of our clients with this information. We welcome transparency and the data it is creating. At ClaimDOC, the only thing we like better than having our program validated in such a sweeping, bipartisan effort is helping our clients offer a cost-effective and sustainable health plan.