Navigating Market Preference – Substance over Style
Five years ago, I joined a call with an experienced broker with a strong firm out of Kansas City. She had a client struggling with plan cost; yet, when we explained our solution, she didn’t believe it would work. She had heard of reference based pricing, but thought it was just conceptual and didn’t think plan sponsors actually did it. Fast forward five years and it feels like we are in a place where the broker community almost universally accepts that referenced base pricing works.
There is continued debate on the definition of ‘working’ and varying opinions from brokers on whether it suits their book of business. Regardless, for a broker to say it doesn’t work these days mostly makes them look ignorant. Instead, the question brokers ask is typically focused on what the market expects once they eliminate the network. Our perspective has always been that employers and their plan participants expect a very similar overall experience with moderate ease-of-use pain for significant financial gain. Viewing ourselves as Network Replacement instead of simply RBP allowed us to build properly from the ground up.
By creating a solution that fully addresses these market expectations, we have carved out a respected niche in delivering a better-than-BUCA experience for the brokers and clients entrusting us with their medical plan benefits. Successful network replacement for each client isn’t a black and white formula but always balances the same core ingredients:
- Member Access
- Balance Bill Support
- Litigation Defense
- Claim Processing
These driving elements tie together like a well-oiled offense in football. (Go Chiefs!) There is give-and-take across all elements with the fundamentals of the program ebbing and flowing alongside the variances of geographic nuance and situational needs. Often a new broker or a client experiencing their first challenges will be yelling from the stands to throw deep or wanting us to punt on 3rd down. Until they see it play out in action for themselves, there is some doubt that our team of experts will properly orchestrate the offense. Fortunately, 10 years into the business we have a good fan base of brokers and clients that have watched a lot of our games and gained confidence in our consistent production.
RBP crossing the threshold into acceptance has created a never-ending flow of ideas on how to better accomplish offering a non-network medical plan. Changes can improve marketability of the program and changes can make the program better. Sometimes it does both, but they don’t always go together. It feels good to give the market what they want and see a pop in sales activity, but ultimately change just slows you down if it is based on hype and not legitimate program value.
What’s wrong with hype – nothing if we are talking about a new sandwich at Subway. In our world of replacing a network the consequences of failure are much more serious than disappointed taste buds. Misleading brokers and clients with the ideas presented as “cures” while ignoring the realities of a comprehensive program is a recipe for disaster. There is a constant flow of new “game changer” programs willing to lead buyers down a path of empty promises. Ten years of experience gives us a pragmatic view of the reality that you can’t measure the impact of changing program elements in a vacuum. We always ask ourselves – how will this change impact another area? Buyers must ask themselves – what am I giving up in total to get this one better feature?
Most fresh ideas we evaluate are theoretical solutions aimed at solving fragments of the overall network replacement equation. These solutions are alluring yet come with significant gaps in overall performance. Gaps that buyers discover down the road and brokers are left to explain and solve while continuously plugging holes in the dam. Soon the buyer is left with an inefficient, piecemealed solution operated by a multitude of vendors. Each advantage of a solution tackling a fragment is mitigated by a lack of cohesion. This results in a plan with clunky member experience or disappointing financial results when compared to an integrated strategy built with a connected understanding of the overall goal.
Innovation and improvement are necessary and will happen at ClaimDOC or we will fail; this isn’t an industry for the stagnant. The market will speak and will tell us what has long term value. We’ve always been nimble; however, we must stay true to who we are. Who we are is a company that values our existing clients and their needs above using gimmicks to chase sales. The focus and effort of our company is and always will be doing the hard work to give clients a successful experience.
It isn’t as exciting as the “solution of the day,” but our narrow attraction to ideas of substance allows us to materially improve more than those throwing up a Hail Mary with flashy marketing. We will capitalize on new ideas; however, getting smarter, getting stronger, and sharpening execution will take us further than hoping for a big play.