Vendor Selections – Who Was Winning Business in 2023
It’s the holidays. Many of you aren’t working and the ones that are likely don’t want a heavy article on why healthcare is broken and what ClaimDOC is doing about it. Instead, let’s keep this light and informative to satisfy any of your curiosity about what others are doing in this space. I can’t speak to the unbundling happening outside of ClaimDOC, however, I can share what our book of business was doing with their TPA, PBM, Pre-Cert/CM, and Stop Loss Market selections. I’ll reference sales in 2023, which for us the sales cycle is February 1, 2023, to January 1, 2024.
We don’t have exclusive arrangements, financial incentives, or ownership of TPAs that can only funnel business to us. I’m sure our sales reps wish they could take credit for sales that were driven by the mothership paying to get that business sent our way, but that isn’t how we operate. For this article, the value is the diversification our book of business captures and the insights you might glean from seeing what others are doing. It’s always interesting when you go to a conference or read something on LinkedIn you can be influenced to believe certain companies are killing it. That’s good marketing, but these stats are the reality. Keep in mind it’s a big world outside of ClaimDOC and I’m not suggesting anything other than these vendors are out there in the market winning business:
TPAs
ClaimDOC is integrated to have our claim system sync with 27 TPAs across the country. There were 14 different TPAs out of that group hired for new business in 2023. We added three new partners for 1/1 business – Professional Benefits Administrators, Paragon, and Sage. The TPA selected the most for new business across our block in 2023 was UMR/HealthSCOPE. This likely isn’t going to be well-received by the anti-BUCA crowd, but UMR earns the business they get. We have regular conversations with claims, systems, and service teams internally to review the quality we are seeing from TPA partners. UMR is consistently one of the highest-performing TPAs we work with. Most of our overall business is still with independent TPAs and we will always support them. With that said, our allegiance is to deliver for our clients and the required sophistication and increased expectations on quality are starting to catch up with some of the smaller shops. There are some rock-solid ones like Diversified out of Connecticut, Group Administrators out of Chicago, or BRMS in California along with many others that will always be great choices to handle your claims administration.
PBMs
I hate to disappoint any PBM rep out there who might have spent money taking Omar Arif or one of our sales reps out to dinner, but we have almost no influence over this selection. Maybe five years ago, when some brokers dabbling in the space were unfamiliar with transparent PBM options, we’d point them in the right direction. When I first started working for ClaimDOC in 2016 our CEO, Ben Krambeck, told me working with PBMs is like squeezing a balloon. You think you have them pinned down on cost, but the air is just shifting to another part of the balloon. That might not be as problematic now as there seems to be good, healthy competition in the transparent market with solid operators. Mark Cuban has jumped in with Cost Plus Drug and powerhouse grocer in the Midwest, Hy-Vee, has launched their own transparent PBM. As I looked across our entire book of existing business there are 31 different PBMs that show up on client accounts. There were 13 different PBMs selected on new business in 2023. It was evenly distributed, but the PBM selected the most for new business was True Scripts. They also show up the most across our entire existing block and touching multiple TPA and broker relationships. I can’t say I know anyone at True Scripts, but they must do a good job.
Pre-Cert/Case Management
This area of vendor selection falls somewhere in the middle of broker, TPA, and ClaimDOC. TPAs often have their preferred partner and it’s not uncommon to offer their own service or a white-labeled service. ClaimDOC certainly has vendors that we have seen partner well in this space and brokers will occasionally have an opinion. We saw 15 different Pre-Cert providers selected on our block of new business in 2023. The vendor selected the most on new business was Innovative Care Management (ICM) and it was by a wide margin. Similar to True Scripts, ICM also shows up the most across our entire existing block of business. They also touch many different TPA and broker relationships. Our staff enjoys working with them from their CEO, Marion Shipley, to their 40 in-house clinicians. In the unbundled space, you often find companies trying to figure out who they are and grow a business at the same time. We appreciate that ICM is a well-established business that knows who they are and stands on their quality and customer service.
Stop Loss
Relationships are everything in the stop loss market when you work in the network replacement business. Finding the underwriters who believe in your solution and your ability to drive savings is the key to getting the risk marked appropriately below network business. With that said, we see business land all over the place for all kinds of reasons. We have about six markets that know our solution really well and reliably underwrite us properly, however, 16 different markets showed up on new business in 2023 and 31 markets show up across our entire book of business. Accurisk won the most new business in 2023 and they show up the most on clients across our existing block. We are big fans of how Dan Boisvert and his team operate and really support the non-traditional market.
I’ve made it through the entire article without a shameless plug, here is a shoutout for Spencer Smith getting our relationship kicked off with Pareto. We advertise on his podcast, so even though Pareto only shows up on a couple of clients I’m going to make it a highlight.
Happy Holidays
Let’s appreciate and celebrate the vendors out there making this non-traditional medical plan world a reality by investing in their business and hiring talented employees to take care of clients and members. It takes a certain amount of crazy from everyone at ClaimDOC to make our part happen and the right support systems to not let us get too crazy. Happy Holidays from the ClaimDOC Executive Team and our support systems.
