New Client Implementation – Broker Skills Prove Vital

We often find ourselves grappling with the fear of the unknown, preventing us from taking bold steps toward positive shifts in our organizations. Particularly in the health insurance space, embracing change can be scary, especially when it has the potential to impact employees and their families. At ClaimDOC, we frequently come across prospects who, deep down, know they need to take control of their healthcare spend and try something new, but hold back due to fear of the unknown. Even after they receive compelling proposals from supportive brokers, showcasing 30-40% savings on healthcare spend for the first year and the extensive member support ClaimDOC offers as a fiduciary partner, there is often hesitation to fully embrace the reference based pricing (RBP) network replacement model.

Shifting mindsets and letting go of something that has been deeply ingrained in us as an essential component of a health insurance plan can be uneasy, but not impossible. So why do so many organizations prefer to maintain a financially unhealthy relationship with their traditional network?

They may worry about

  • effectively educating their employees
  • employees not engaging and following necessary processes
  • having the resources to manage the program
  • the potential challenges that a change in insurance plans and network replacement may bring.
  • an article they once read that warned them about the “horrors” of RBP and how it subjects patients to balance bills leaving patients financially vulnerable

At ClaimDOC, we value transparency with our clients, members, and provider partners because we recognize and understand the dynamics of implementing a new health plan. We believe education from day one is the cornerstone of a successful RBP plan. 

Starting with our clients, we foster open and honest lines of communication to arm them with knowledge and understanding of the program. We address their concerns head-on and dispel misconceptions surrounding network replacement by presenting them with detailed solutions and processes. Our Account Managers work closely with clients to understand how their employees learn best. Then they provide them with comprehensive member education materials that focus on teaching the basics of referenced based pricing, how to navigate their new health plan (from access to billing), and how to respond when things don’t go as planned. The goal is to build a strong support system through frequent and relevant educational opportunities to shift the mindset of members and empower them to engage with ClaimDOC to make informed healthcare decisions. 

Our broker partners play a vital role in this education initiative and the overall implementation of a network replacement health plan. Active and engaged brokers who place their trust in us and the program become invaluable allies, working closely with us to support and educate clients and members. These brokers understand some challenges are inevitable and know how to set proper expectations for our mutual clients, mirroring our goal for transparency and collaborative resolution throughout the journey. The key is for the Implementation Team to find the right mesh point with the broker teams. ClaimDOC works with a spectrum of broker partners, from those who embrace us as a visible co-pilot to those who want us to support from the background. What’s important to us is the success of the program and not who gets the credit. We can be effective in both scenarios; however, we need partners that bring two things to the table:

  1. Trust that proper education and communication that aligns tightly with the nuances of our specific program will create long-term success
  2. Fully vested in the program

There may be challenges. The most consistent indicator of program failure is when brokers inadvertently fuel fears or don’t properly set expectations through thoughtful education. Those brokers lingering on the fringe of interest in RBP don’t give themselves enough credit for their ability to deliver the solution to clients. Like many things in life, strength and humility will lead to success. I’m not just talking about the success of the elements ClaimDOC guides. Some brokers possess a presence that inspires all stakeholders to function collaboratively and effectively at levels others don’t achieve, regardless of their level of attention to the client. I find them inspiring both personally and professionally.

So, let’s delve deeper into the spectrum of results recent clients have experienced during the implementation phase.

ClaimDOC’s dedicated onboarding team begins offering support as early as 60-90 days before the plan’s effective date. This allows us to get to know our client, create educational materials, develop a roll-out strategy, participate in open enrollment meetings, and kick-off our provider onboarding program, Pave the Way®, ensuring a smooth transition. Once live, we continue to closely monitor the plan’s performance during the implementation phase, which typically extends for approximately 90 days post-effective date. This phase allows us to address concerns, ensure everyone feels comfortable and confident, and make necessary adjustments.

One success story comes from a 400-life group based in Florida using OneDigital. ClaimDOC and the consultant prepared a proposal to offer members the choice between one plan having a full nationally recognized provider network and the other utilizing ClaimDOC as a network replacement. Their experience with ClaimDOC was positive from the outset. The ClaimDOC onboarding team, broker, and client collaborated closely, ensuring transparency about the potential challenges of a reference based pricing plan. A comprehensive open enrollment education program was implemented and delivered by the team, resulting in more than 90% of the population enrolling in the ClaimDOC plan. Once the plan was live, clear lines of communication were maintained to ensure timely resolution for members when things didn’t go as planned. As a result, the group had a smooth transition, demonstrating the effectiveness of proper collaboration and education.

In contrast, a 200-life organization located in Florida had a less than favorable experience. The broker wanted to establish control (which we are fine with) and used their own communication pieces, but they missed the mark. They lacked substance on the critical elements. The client then decided to soften and control the messaging at open enrollment. Unfortunately, the proactive use of Pave the Way®, which is designed to build relationships with members and health providers, was not effectively utilized. This lack of collaboration and engagement hindered the program’s progress. After several months the struggles led to a reassessment by all parties to follow a more proven member engagement path, and we are seeing success. Our Implementation Managers walk a delicate line in the broker-client relationship. The goal is plan success, however, we know without the broker, there would be no client. 

These experiences highlight the importance of various elements in successfully implementing a network replacement health plan. The first six months of the program can have a range of experiences. By proactively addressing concerns, providing education, setting proper expectations, and fostering collaboration by all parties, a smooth transition can be achieved. With ClaimDOC’s proven track record of successful implementations and a commitment to supporting our clients and members throughout the process, overcoming the fear of the unknown and taking the leap toward network replacement can unlock a financially brighter future for organizations and their employees.