Chicken Little and PHCS

I was asked to write an article expressing our position on the recent news that PHCS would only be allowed alongside HST on RBP business. The answer is so simple, but I didn’t think readers would want another write-up on Pave the Way® or Direct Primary Care, so instead, I’m going to climb onto my high horse and talk about PHCS going away in general. If you are reading this and don’t know about ClaimDOC Pave the Way® and the success it drives, please send me the name of the sales rep you work with as I will personally review their existence on our sales team. 

What would I say to the decision makers at Multi Plan about limiting competitors of HST from using PHCS? I would say, “THANK YOU.” ClaimDOC and HST are not really true competitors due to their limited solution and this change hurts everyone except us. HST is sold by brokers who don’t realize they are sending clients to Burger King rather than paying someone to prepare fresh meals in their homes. It may cost a little more upfront. However, if you understand the value and long-term benefit, then it’s an easy decision.  

There is a spectrum of RBP vendors that aren’t quite as bare bones as the deep discount PEPMs and can probably spin a story to try and match ClaimDOC’s value proposition. Those vendors rely on PHCS because they can’t do anything like Pave the Way®. Or worse, they rely on double-dipping clients by selling their network with imaginary discounts that savvy brokers have exposed. This is why, again, I want to say, “thank you, Multi-Plan, and good luck with that stock price.”

Some of you may find my attitude toward this a bit off-putting. The prophet, Tim Tebow, encourages us to be kind to each other. I’m not trying to be unkind toward HST/other RBP companies or those who support them. However, I am jaded by the stories we are hearing from knowledgeable brokers. There is a difference between being upset about common hurdles with RBP and being upset about inexcusably poor service. There are different philosophies on delivering RBP, and we can appreciate that. However, we believe in what we do and why we do it. The mission to create affordable healthcare for the working class is an increasingly popular topic by stakeholders yet the execution of achieving these stated goals is deteriorating. Existing businesses are satisfying investors, and most startups would rather pitch their idea to investors than leverage themselves to fulfill a mission. Experience, expertise, execution, and substance are becoming subordinate to gimmicks.

There will always be a flavor of the month trying to break into RBP because from the outside it looks like a great way to make money. RBP is a complex business where you need to be laser-focused on the mission and ready to spend millions on custom systems developed from the ground up after workflow processes have been tested under pressure. You don’t even know what you don’t know for the first five years. We were recently told a new entrant does everything ClaimDOC does. Although imitation is the greatest form of flattery, do not be fooled. Saying something and doing it are two very different things, especially when it comes to a passion-driven model such as ours. A simple Google search showed in late 2018, they were a startup using blogs to kick start their business and RBP wasn’t part of their mission.  

Ten years, over a million claims processed, and tenaciously loyal staff dedicated to learning and developing better systems and processes can’t be replicated simply by having deep pockets. It’s hard to take existing staff in place working on other products and then change course to RBP and think the heart of the company magically becomes driven to deliver RBP. When one says they are “just like ClaimDOC”, many questions arise: how do they map CPT Code 77049 in an audit; what is their Member Advocate process when a provider is unresponsive to outreach and education; the list goes on. Quality is created by situational awareness of experienced staff committed and able to navigate and solve unique issues. Quality is created by the program’s less-noticed nuances, which together create strength resulting in exceptional performance and client satisfaction.  

I love that we have experienced RBP brokers telling us they can’t put their finger on exactly why our plans run differently than what they experienced in the past with other RBP vendors. There is not one thing. It’s a product of putting your entire heart and soul into a solution. We do our best to hide the rough edges our tenacity creates because the broker community isn’t always comfortable with it. Our passion and tenacity are who we are as an entire company and what our clients benefit from. We are the rare existence of a company with comfortable cash flows and highly developed systems and infrastructure paired with staff who have gravitated to us because they like to get up and fight every day.

The sky is not falling now that PHCS is limited to working with HST unless, perhaps, you are an RBP vendor that took shortcuts in building solutions. Our clients will be just fine. This isn’t a narrative concocted as a reaction to recent news; this is from developing a solution that our CEO knew had to exist to offer a sustainable alternative to the traditional fleecing.