Webinar Replay

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A practical, end-to-end discussion on where large group ASO sales stall — and what payer teams at Kaiser Permanente and Sentara Health Plans are doing to streamline the process from RFP to renewal.

Transcript Sections

01Welcome and Housekeeping0:01 02Setting the Stage1:24 03The Metrics That Signal Trouble4:34 04Where Deals Stall: Friction at Kaiser6:42 05Communication and First Impressions8:33 06Beyond a Benefit Match9:33 07It's Not the Product, It's the Process13:04 08Cross-Functional Friction14:14 09Building a Single Source of Truth21:53 10Getting Quoting Into a System26:37 11Change Management Is Everything28:41 12Modular Products and Regulation33:32 13Just Because You Can Doesn't Mean You Should37:32 14The Last Mile: From Sale to Claims42:05 15Q&A: Change Management49:12 16Q&A: When Things Go Wrong51:56 17Q&A: Freeing People for Higher-Value Work56:34 18Closing58:46
Transcript
01

Welcome and Housekeeping

0:01
AHHost

Hello and welcome to today’s webinar streamlining large group ASO sales from RFP to Renewal. Before we get started, I’d like to review a few housekeeping details. Today’s webinar is being recorded and an online archive of today’s event will be available within one to two business days. If you have trouble seeing the slides at any time during the presentation, please press F5 to refresh your screen on a PC or Command R if you’re using a Mac. You may ask a question at any time during the presentation by typing your question into the Q&A box that you see located on the right side of your screen and pressing Enter there. And finally, I’d like to remind you of AHIP’s antitrust statement located in the link just below the slide viewer. We will, as always, comply with that statement. Among other things, the antitrust statement prohibits us from discussing competitively sensitive information we’re very fortunate to have with us today. Margaret Medlin, Senior Vice President at Simplify Healthcare. Brian Hunter, Executive Director, Customer Benefit Engagement, Kaiser Permanente and Annie Alexander, Vice President of Sales Solutions at Sentara Health. And at this time with that, I’d like to turn the floor over to our speakers.

02

Setting the Stage

1:24
MMMargaret Medlin

Hi, everyone. Welcome. Thank you for joining us today. We have a great discussion plan for you all today. What we’re going to be covering is really this topic that I think is quite a challenge for many health plans across the nation here. And this is really the large group fully insured ASO sales process. So we’re going to be kind of covering end to end. What is some of the friction points in that sales process and then what are some pretty practical examples of where we’re finding success with helping improve that process along your way? So I am Margaret Medlin, I’m the SVP of product management here at Simplify Healthcare. We work with many health payers across the country on this topic. And I am joined today by two fantastic guests, Brian and Annie. And so as we go through the topics today, really you’re going to hear directly from them. We love to make these sessions as practical as possible. So you’re really walking away with some tangible advice that hopefully you can apply at your own organizations. And as she mentioned, please enter questions as you go in the chat. We love the questions and we’ll have a ample time at the end to go through those. Q And as with you, one note I will say is if any of you on this call are actually going to be joining the AHIP conference next week in Vegas, I’ll be there as well. So happy to meet you in person as well. So with that said, before I really get into some of the some of the nitty gritty details, I wanted to literally just set the stage with everybody about what is the challenges that we’re all facing here in this space. So when I think about the topics that we want to cover today, and as we go through the content, really it’s going to be focusing on where are we seeing these large groups deals stall? We know that for all health plans really that book of business is quite important to everybody. And so while it’s so valuable from a growth perspective, operationally, it’s got a lot of challenges, right? So we’re going to kind of breakdown where are we seeing those issues, whether it’s within different cross functional alignment issues, data silos. So we’ll kind of breakdown between process and technology and also what are we actually seeing work in inside these organizations? So we’re really going to kind of dig into these and you can see towards the bottom there. One of the things near and dear to my heart is what are some metrics that we’re all using to track this, right? Because I think that there’s some key metrics that’ll help people understand how mature is your process. And then maybe where are some of the areas that you might want to dig into a little bit further because it’s quite a large transformation ahead of you.

03

The Metrics That Signal Trouble

4:34
MMMargaret Medlin

Speaking of metrics, I just pulled out a couple before we really dig into the questions and I think of like the benchmarks, right? When you’re talking large group sales, some of those metrics are obviously what’s my conversion rate? How many of those new groups are we winning? And then what’s our renewal rate? So one statistic is kind of looking at that conversion rate from quote to bind, right? And if your organization is in this large group spaces maybe falling below the 10% mark that’s probably an indication that you really need some transformation in that space. I would say average we’ve heard across the payers is maybe like 10 to 25% again, depending on the size of the group, right. Another key metric in this space is just your time, right? How long does it take to get through that quote cycle? And again, depends on if we’re talking fully insured ASO. But I would say on average, if you’re over the 15 day mark for just a pretty typical quote you’re probably in an area where you need to really kind of do some transformation even ASO. I would say typically maybe if you’re creeping above like the four week mark maybe that’s a sign, an indicator. And the other quote here is just the manual process. When you think about your own organization and you see where your process is, you’re what you’re looking for is where are the manual steps happening and what is the rough percentage across each of those? And so I kind of some statistics here for benchmarks is if you’re at the 85% plus mark where there’s a lot of rekeying of data, etc.. Again, that’s a good leading indicator that you might be in need of some transformation. So I just wanted to kind of set the stage for some of these key metrics that are leading indicators to, for your own organizations to think about. But with that said let’s dig in. Let’s meet our presenters here today and start getting into some of the details.

04

Where Deals Stall: Friction at Kaiser

6:42
MMMargaret Medlin

So Brian, I would love to start with you. What are you seeing are some of the friction points in your sales process over there at Kaiser?

BHBrian Hunter

Sure. There’s a whole lot of different pieces that get moving in Kaiser when a quote comes in a lot of what we see is making sure that we’ve got clean data capture and really understanding what the customers wanting. And this is kind of different based on market segmentation. So things that are more mid large off shelf portfolio, more limited customization, I think that’s less of a challenge. Once we start getting the larger strategic customers, it’s really about how do we engage expertise from around the organization, bring them to the table that work with the groups directly and then start carrying some of that through. And if we don’t get that right, it goes all over the place, right? So you end up with delays, you have rework loops, you’ve got issues potentially that could show up in an installation down the roads, which is never a good customer member experience either. So we do a lot of trying to track monitoring on quote times. We look at rework loops and minimizing that. And when those things do happen, we end up going back and looking at it. But I would say primarily it’s been around making sure we got clean documentation, a very good understanding about what those groups and brokers are looking for, and then making sure that’s communicated in a manner that is consumable by other areas of the organization that need that, right? Like, I think of the snowball effect, right? Like in that very first step, if you’re not understanding what they’re asking for, right? Unfortunately, subsequent steps you might be working off of a false impression, right? So very resonant to what I’ve heard with other pairs.

05

Communication and First Impressions

8:33
MMMargaret Medlin

Annie, what are you seeing over at Sentara?

AAAnnie Alexander

Yeah, I would agree a lot of the same thing that Brian said. I think we really try to make sure that we communicate in the same way. So we have like a lot of templates and a lot of things that the team has agreed to, making sure that we have the right people around the room, especially with our more larger complex ASO customers and just really understanding what’s unique to them and how we can implement it. Obviously, we always love to be the earlier the better that we know, right? But sometimes you don’t get that, you don’t get that and you have to just kind of focus and make it happen. But I think to Brian’s point, communication is key. Making sure you understand what the customer is looking for, what their expectations are, setting expectations right, especially for the more complex ones. You do need more time to make sure that you deliver a quality product and a great first impression.

06

Beyond a Benefit Match

9:33
MMMargaret Medlin

Absolutely. And I wanted to poke on something both of you said, which is, or maybe I was reading a little into it, right? But it’s this idea of you’re getting groups asking you match my benefits, right from a, from another carrier. And I hear a lot that great. We want to make an efficient process so that we can get that quote right back off the door quickly because that’s natural what they’re asking you for. But there’s a often times there’s a gap where I the plans are telling us we wish we could even go out to them with more alternatives, things that we’ve excited about, we’re excited about from our product perspective and our business relationships perspective. So I’m curious, have you guys noticed that as well that might be an enterprise directive to try to be able to get in some of those alternate quotes, I’ll call them with that are more directive. And how have you been able to do that? I guess have you been successful at trying to implement into those like alternate quotes? And I’ll just throw this out to either of you if this is something that you guys are dealing with. I didn’t want to talk over you.

AAAnnie Alexander

OK, right. I would say we try to do both, right, because you want to be a partner and an expert right in your field. So you want to first and foremost, again, just kind of understand what they’re looking for. So it’s not necessarily like a one to one match of what they currently have, right, Because then what would it be unique in order for them to make the move, right? So really just focusing on your unique traits, how can you better fit the needs of their employees and really meet them where they’re at. So I think it’s a combination of both. You want to make sure you understand what they need. And then you want to make sure, how can you level up what they already have? Because it’s a big amount of work to make a move like that, especially for a larger employer. So you have to make sure you build that value and that you match what you’re able to offer to meet that value for the customer. So I think the larger you get, obviously the more complex it gets to make sure that you’re meeting that need, but it’s about having good understanding and making sure you can level up what they’re already experiencing.

MMMargaret Medlin

Absolutely. Well stated.

BHBrian Hunter

I think the only thing that I would add too, from a Kaiser perspective is sometimes our offerings are a little different than maybe a more strict non integrated plan. So a lot of those kind of offerings that we bring back are similar, right? It’s highlighting strengths or alternatives that may work with our ecosystem and how that works. And have really gotten that muscle strong in terms of saying here’s something that may not look exactly the same, but is either equivalent or to Annie’s point kind of levels up what that experience would be for them as a group.

AAAnnie Alexander

Yeah, Integrated Care network is also a huge win, right? I think Brian, as you were suggesting, right, we can really leverage that to show the difference of the experience that you get and how we’re able to work as a full system and understand the full spectrum of care as their employees go through what they need. So I think that’s a big one for us too.

07

It's Not the Product, It's the Process

13:04
MMMargaret Medlin

Yeah, I think what I hear from the payers is right, product is not the issue, right. Like there’s great products that they’re offering to the market. There’s great not even just individual products, but as that full package. So that’s what I’ve also seen across the payers is you’re, you’ve got great products to offer, right? You’ve got great networks to offer, right. You’ve got just great servicing to offer. And so really, when it’s thinking about some of those key metrics in the sales process, about where you might be not winning some of the those deals, I think that’s what we’ve seen as well is to focus on. OK, great. Like where are some of the friction points coming in? So maybe let’s dig in a little bit deeper into that cross functional alignment, because obviously getting a one quote out the door takes a village, right? If I break it down not only is product got the right product, but again, I think that there’s pretty confidence there, but just getting it hooked into the broker portals, the shopping experience, like that whole interface, obviously CRMS underwriting, etc.. So Brian, maybe I’ll start with you.

08

Cross-Functional Friction

14:14
MMMargaret Medlin

If you can kind of just give us an insight into in your cross function alignment through all those steps, where do you see maybe the most friction point happening?

BHBrian Hunter

Yeah, the challenges are, and it’s funny because I was thinking back as you’re talking about some prior organizations where I’ve seen everything from highly sophisticated Excel tools that are dropping copies of files and folders and being used for quotes. And anytime you change one thing to your point, you got to go through the insane rigid process. You can’t change one thing and get immediate feedback on that. And I think some of that fractured process and tools still exist, right? Like we’re continually working and we’re finding it. But I think from an internal perspective, it goes back a little bit to my opening statement around making sure exactly what it is that they were wanting to purchase and having that in the format that can then be pliable or consumable by other systems, right? And making those really same, because I think a lot of organizations have probably grown up using legacy process manual translations. This system has it listed as specialty and this one is specialist and it goes through somebody’s inbox and drops in as an Excel spreadsheet or whatever it is, right? So you lose visibility, traceability that introduces delay. There’s quality issues that can show up from that as well. And so really trying to move as much of that upstream as you can and to kind of single repository, it meets different lenses and different needs from those systems. And it’s something that we’ve really been trying to focus on to remove and kind of smooth out those points because it’s not great. If you’re an internal employee, it can be annoying trying to deal with some of those manual things. If you’re a group from the outside, they may not see all the gory details, but they’ll know that there’s delay and then to your comment around the snowball effect, if something does get missed, then you’re doing root cause analysis. I’m trying to find out where those things happen and go back and fix that, which also takes time, right? And it’s hard to pinpoint exactly where and isn’t probably great from a experience perspective, reputational and there’s different impact points all over the place. And that doesn’t even get into things that if it goes real S regulatory issues or risk, they could get introduced as well. So that’s what I would say is really it’s just those manual processes and lack of centralized systems, right? And you remind me, I think you both mentioned this earlier about ultimately you want to make sure what you’re presenting is it’s consistent, it’s impressive, right? And So what you’re reminding me is when and let’s take these are large groups where you might be pulling in internally from a lot of different teams right across regions, across different lines of business, etc.. And so when you are ultimately getting that quote out in front of them with pricing you also want to make sure it’s cohesive if you will, right? And so that way because I think that is something that would lead to more adoption option essentially, right. Like they’re they’ve just been spoon fed essentially something that’s nice package with the bow and easy to understand. So, Annie, I’ll ask you kind of the same question though, where in all that cross functional workflows, etc., where have you seen maybe the most friction? And then maybe even you can start to pepper in some of the where have you seen things maybe where small change might actually make a big improvement in those friction points? Yeah, I think we’ve gone through a lot of transformation over the past year, specifically around large groups. So we are trying to get into a consistent flow and system because I’m sure many of us are very like we’ve done large group the same way for 30 years. It’s been an e-mail and meetings and things like that. So we have slowly started to get that into a system which has really helped with those fractions like friction points. It’s definitely not perfect because it’s the beginning foundational phases. But I think just making sure the true cross functional team because especially with ASO customers, they can have very specific requirements around clinical programs and around their network and pharmacy and just all of those things. But we were really used to having like a red line, right? We start most of our, pretty much all of our modified benefits with our core benefit, right? So I think having that structure of saying this is what it started with and then this is what we’re changing really helps making sure that the cross functional teams understand like where are we going outside of the guardrails, right? And then being very clear on what does that impact from a clinical program standpoint, what kind of commitment do we have for even technology, right? Like some of our larger customers, we stand up websites for them. We make sure that we have additional reporting that we need.

AAAnnie Alexander

So just making sure that we have that documentation, which I know you’re going to hear me and Brian say that a million times, but that’s just really where it’s at is documentation, communication, getting people involved early, making sure that it’s priority, doing a standard around, hey, this is when we need to get back and we have a commitment to make sure that we have an update to a customer. But I’m just those hand offs and ironing those out are super critical. Yeah, absolutely. Those SLA’s that we all have. And just the logistics, right, of just coordinating workflow internally. So you can not only meet the SLA, but meet it together, if you will. Yeah. And I know that. When I think about this type of large scale transformation, right? And I was suggesting for folks here on this webinar is thinking about your own process, right? Like breaking it down, who are the key people involved? And then each step in that flow asking themselves, OK which technologies are in play with each of these steps, which group people are in play with each of these steps, What are my SLAs at each and stuff. Literally just having that written down, right? And so that if you’re in charge of if your sales team who’s in charge of the sales, it’s just so they understand what all of that looks like.

MMMargaret Medlin

Because when I’ve seen when folks are coming in to us and asking for help with the transformation, that’s usually the, one of the first questions I ask them is like, show me your current process, right? And then each one of these little handshakes, right? Tell me what’s happening at that handshake? Where’s the, how is the data being passed over? Are the teams how is the workflow back and forth? And there’s questions because there’s always questions, right? And that’s honestly just the first place we start as well because full scale what’s it called, Big Bang transformation is just not possible these days, right? You really just got to pinpoint where’s the right place to invest in and so that you can like slowly but surely keep introducing new process changes, new technologies, etc., and just to kind of keep moving the needle. And then I think the other key thing is for each one of those having that metric so that as an organization what good looks like, you’ve set a benchmark and expectations for people, and then you can monitor like how well are these improvements actually happening? So I want to poke a little bit more on the data.

09

Building a Single Source of Truth

21:53
MMMargaret Medlin

Like I was just mentioning each one of these handshakes is really a data handshake as well. And So what we’ve seen a lot of the times is and this is where that whole manual work manual percentage of time comes into play is that a lot of times the data is rekeyed into every system. Might start in CRM opportunity rekeyed into some word documents, frankly, benefit grids, frankly, things like that rekeyed over the underwriting rekeyed into the document system. So Brian, you kind of touched on this a bit too, that you guys at Kaiser have started going to that single source of truth. And just kind of curious if you could share with the team a little bit about what that journeys look like and kind of some of the challenges that maybe you face with it. But kind of really the really what caused you to actually decide like this is going to be one of the more valuable things for us to start with.

BHBrian Hunter

Sure. So we once again legacy process has worked in worked it’s way and is always present, right. So we had different tools and some of that frankly was driven by Kaiser’s fully insured different markets. So there was some history there. There’s differences based on line of business, right? And some of that persist and we’re not here to talk about small group and individual type products, but those look totally different because of the set of regulations they have and what you call out versus ASO, which may be more expansive versus fully insured, which you have to make sure things like regulation at state level are present too. So over time, you’ve got different formats that are categorizing, labeling things in different ways. And so different pieces of documentation have kind of sprung up. And so really trying to harmonize that and come up with a single set that kind of captures all of those various pieces has a lot of efficiency, right? You’re not maintaining multiple processes, you’re not taking and then having to retranslate things into different systems. And so we recognize that there was an opportunity there to establish a more centralized kind of product catalog type idea around that with guard rails and things that would be configured by people closest to the work, but they wouldn’t be available and then inform kind of to your point around connectivity, right? It informs the sales processing system, it informs document generation potential in some areas. And the more that we can kind of consolidate and you start from one place and that’s your portfolio, your guardrails and everything that’s there, it starts branching off of it rather than my intent and my starting point was a spreadsheet that has this nicely documented, but then somebody’s got to go set it off to the next person with red lines and markups and everything else, which we’ve totally been there Annie and are still there. And I’m not going to say it’s totally behind us. So but that, but those are the types of things that are really pushing for that change, right. And so then once you get that data set up, it’s all around how far do you take it to your point? You can’t do every system everywhere all the time because you’ve got well established administrative systems, you have pricing systems that may need it in a particular way. And so you start addressing each of those different components and building that ecosystem over time. But one thing to kind of call back to your prior comments around evaluating process, looking for friction that I think we have to be afraid to challenge it and say, is that step even needed, right. And it’s the process to begin with, right? So it’s not just about approving it, but actually saying, is this really the most effective way to do it? Are we structured? Is our process working? And some of that, I think you can ask those questions differently. Once you do have data in a way that can be consumed and used, right so you’re no longer saying we need this step in the process and this team’s just taking this and moving to the next piece or whatever it is. And can we shift that to being higher value work that they’re doing rather than the manual pieces? And it opens up a lot of possibilities for process design and where did we do organization?

MMMargaret Medlin

So, yeah, I think that’s a really common theme we hear is that people want to be doing more valuable work than rekeying data and everybody does. And we at some point we meet with really like the folks on the ground working on this, right. And when I hear people thinking about oh, if you’re trying to automate a process more, does that mean we’re trying to take the humans out of the loop? And I would tell you guys overwhelmingly that it’s not at all what people are why they’re wanting the automation. They’re wanting the automation so that those people can do more valuable tasks like such as create those alternate quotes, right. And so that’s just overwhelmingly what we hear as well.

10

Getting Quoting Into a System

26:37
MMMargaret Medlin

So any similar question to you though when it comes to all of those data flows etc., Where are you guys with that journey of trying to help either reduce the rekeying or manage it in a better way?

AAAnnie Alexander

I mean we’re still at the beginning phases. I would say our quoting, we have got it into a system where we can quote, I brought up redlining, but it is through a system we just kept like the experience the same, but they redline and when they accept those changes, it actually pushes it back into the system. So we’re kind of prepping to get it all in the system first. And then to Brian’s earlier point, then how can we send it out, right? Because we still are manually creating our documents outside obviously the proposal is generated in the system, which is great, but there’s even improvements there because we want to be able to have it more customizable, right, especially for large group. I want to pull in this value. I want to pull in that value. I don’t want to leave. I don’t really need that value add for this proposal, that kind of thing. So I think we’ve got a good start and a foundation of actually getting a large group into a system. I would be very transparent and say this was the third time that we’ve tried to do it. So third time is a charm before I was here. But evidently history says that we tried it a couple times before and it just kind of fizzled out and was like, we can’t do it right. So it was a huge feat just to kind of get it into a system. And so I think we’ve got a good start. And then I think the goal is we’ve started sending data out, but we’re not using it yet. So we’re looking at how that looks so I think and then those workflows between this between the teams for approvals is in a system. So we can see like OK who has approved, who hasn’t approved? What type of approvals does this need? So we’re getting there. It’s just baby steps.

11

Change Management Is Everything

28:41
AAAnnie Alexander

So, and I think to Brian’s earlier point too, for change, man, I think change management is a huge thing, especially when you’re talking about a process that’s been the same for like 30 years, because they’re used to having it the way they’ve always had it. We’ve always done it this way or that way. And so I, we went through a lot of change management with the team, even just to get it into the state that we’re in. And we’re still going through it, right, because we’re still evolving as we’re trying, I get more functionality within the system and all of that kind of stuff. But having people as part of the process is a big deal. The people that actually are doing the process and understand it and can be engaged and helping how we can improve it. And this is a starting point. This is not the end, that kind of thing.

MMMargaret Medlin

So, yeah, I’ve been working in tech transformation really my whole career and starting developer analyst, like working my way up. So I was very hands on the ground for a long time and that is, I would say the number one thing any is change management. And I think that bringing people along and moving them into a new world, it’s scary to them. Like I say this all the time to people when we’re like kind of doing our implementations with our customers around that I said, you just have to acknowledge this is they’re afraid. They’re afraid for many reasons. And a lot of times the fear is I don’t want to let my customer down I can’t or for a regulatory friend, I can’t, I cannot let the regulatory down right. And so I think it’s important with any type of transformation that you acknowledge that and that you have a pretty good change management work stream along the way as well, right? And what that really means is you have to devote time to it. You have to say, OK, what does this team need? If I need this metric to change to this, right? And I expect let’s use the turn around time the SLAs, because that’s a very common one where clients will come to us and say, OK, I need my quote. I’m doing 9 day quotes right now. I needed to get it to three days, right? So it’s a very tangible metric that the ROI is built on. And so we say, great, like who are the people involved in that, right? Because you’re asking these people to basically do something differently to get that, to get that number down. And then it’s around bringing them along in that experience. Because what I’ve also seen is we might get really excited during an implementation of a new either a platform or even just a small portion of the technology. But then you deploy it and there’s not a, there’s not a good adoption of it. People are upset they’re not using it, you’re not sure why they’re not using it. And often I’ll trace it back to, well, you didn’t bring them along in the journey and make sure that they understand why this is important and make sure that they’ve got full of trained on it, etc.. So I think that’s one of the advices I would give to anybody, right? Is, really is really pay attention to that because the success of any transformation you take is really kind of dependent on that adoption, right? If you’re really going to get the metrics you’re looking for.

BHBrian Hunter

Agreed on that. So sorry, just real quick comment. I was going to say the other pieces, not just leading with technology too is right. So I think that’s a trap that I’ve seen numerous times where there’s a solution that’s introduced. It’s not solving a particular problem. And so you need to come up to your earlier comments on process and really define what it is that you want to be make sure that the technology matches that, not just have technology running out in front. And then when the business users get in there’s a lack of adoption. They feel like they were cut out of the process. So it’s just to really double down on that point. It’s huge to bring them along, have them drive, be participatory in the vision and the actual execution on it. And then all the way down into design specs and what the user experiences, which is a huge piece that sometimes gets overlooked. So just to call that out. Sorry to jump in there.

MMMargaret Medlin

Absolutely no. And I’m literally the tech partner and I would tell you that as well. When I come into a new customer or existing customer and I hear the whole conversations around like tech capabilities, I’m always like, wait a second, let’s back up. Like, what business problem are we solving here? Because I can tell you about our tech capabilities all day long, but I don’t know if you need them, right? Like, let’s figure that out first. So I really appreciate that comment and yeah, I’m a big fan of that. Brian, I wanted to pick up on something I think that you were talking about earlier, just like if we get into like the product space a little bit deeper about personalization.

12

Modular Products and Regulation

33:32
MMMargaret Medlin

So, and I think you guys both are basically mentioning this, right? So the clients are asking for things and when they’re ASO, they’re asking for all sorts of things. And So what you’re trying to do, I imagine, is really craft modify these benefits within your guardrails to something that is really attractive to them. And so one of the things that we spend quite a bit of time on here at Simplify is helping customers figure out how to create more modular benefits so that as these ASOs or fully insured or even the regulations come out and you’ve got to adjust them. I think there’s a new infertility regulation coming out this week, I believe or in a few weeks from CMS around the ability plans can offer a sort of carve out infertility products, right. So to be able to respond quickly to those either requests from the large groups or CMS, new regulations we’ve seen a lot of customers ask us to help them create these modular benefits so that it’s faster basically to like respond to their requests. So I’m curious for both you, Brian, I’ll start with you. How has that experience been with you? And maybe even think of like the broader stakeholders that you need to bring along for that. Just give the audience a little bit of flavor for how that experience has been over at Kaiser.

BHBrian Hunter

That’s a great question. I would say before I even get into the technology and the offering portion of it, when new things are being introduced past industry changes, we’ve got teams that will pull that in. You have to understand what your organization’s position is on it, right? Often times these things from regulatory lenses are not 100% clear cut, as much as we would love them to be. There’s a level of I would say art and the interpretation that comes with that and understanding what is possible, how that actually impacts operations and really getting crisp on what that is, what your policies are before you can ever go to talk to people, right? So there’s the first way, if you’re going to get questions from people outside the organization asking what your position is on it, are you planning to offer it? So it has to happen in pretty rapid succession there in terms of reaching out to people and understanding what that is. Once you figure that out there’s kind of two paths for talking regulatory, there’s the in effect immediately, right? So you start have to understanding what impact that has to in effect contracts what notifications may need to go out and there’s a whole slew of activities that go with that. And then there’s the future facing component around how does this impact our offerings in the future? And how can we make that to where it’s either a carve out or not or take advantage of whatever that framework is that has been decided, right? And that’s where we start getting to system design. We change things can we turn this on, turn this off, allow that flexibility? Do we even want to allow flexibility? Does that create undue administrative challenges for us where technically you could do it, but you’re going to have to hire 10 people to make sure that it happens and it’s a needle in a haystack type thing. And so all of those are decisions and questions you have to ask. And then it starts influencing the data, the tools and things that you actually produce and let the market interact with and sales staff and things like that. So that’s more or less how we, my words. There’s others who might describe it differently, how we kind of tackle these things when they come in. And then just due to the aggregated nature, it’s a pretty extensive review of these things because it doesn’t end with claims payment. If there’s impact to the care delivery side, clinical protocols, you really got to go deep. And so you’re shaking your head, which probably is a similar experience, right, where it extends beyond maybe what a traditional health insurer would have for sure. Any anything to add to that? That does great, Brian, Thank you.

MMMargaret Medlin

Yeah, I think you said it well, Brian, I would say the same thing.

13

Just Because You Can Doesn't Mean You Should

37:32
AAAnnie Alexander

We just have to sometimes because you can doesn’t mean you should. So to Brian’s earlier comment, like, will it take 10 people or quality matters, right. So if it’s a oh, we could do it. But is it really worth it? You want to stand behind your quality, what you’re going to deliver. And sometimes it’s about just educating your customer to say what, I know we think you want this, but these are the risk associated with that. And So what about this, right? And so I think Margaret kind of goes back to your alternative, right, to be their guidance and make sure that we’re also being an advocate for on their behalf, right, on shedding because we have a different perspective than they have. So we should be able to share that if that’s really what’s best for them to consider. So I would just echo like, just because you should doesn’t mean you always should, just because you can. So absolutely. And as a tech partner, people always ask me, can you? And I always kind of joke. I said, I can do anything from a tech. I go tech. I was told that when I first got into technology, they’re like, Annie, if you have enough money and enough time, you can do anything. And I was like, wow, yeah, tech you can make it do anything. But should you is the right question to be asking?

MMMargaret Medlin

I would say that when so when these like I said, when the, when CMS is putting out new regs. But then more importantly, like I think when you guys are doing your competitive intelligence and you’re really looking at your partner strategy as well. And you’re really trying to figure out like what is our product strategy for this market? I think it’s reminding folks to double check all the implications on the back end of that, right? Like of course we could do this, but these pieces of the puzzle have to change in order to incorporate that. Otherwise, each of those quotes is going to take six months to actually get built. I did have you reminded me of 1 customer, this is years and years ago where they were just so frustrated with sales sort of writing a bunch of comments on their intake form of just really crazy stuff, right? Throwing it over it got sold somehow it got raided and whatever priced and it got thrown over to implementation. And it took them six months to fill that out in the claim system to actually operate with these crazy claims rules. And the group left after the year. So real bad ROI there in that example. So we want to avoid that. We want to, it’s like here we are in this world where we absolutely want to give the especially the ASO customers these nitty gritty things that they’re asking for. Of course we want to. So what that really means is yes, we also want to kind of maybe. Guide the ASO into something that’s maybe a little bit easier, that’s still very robust and beneficial to their groups, but something that might be already like easier to build. But when that’s not on the table, when you have to be able to implement something that’s pretty specific I think having those abilities to have a modular benefit structure that is easily extensible. So I use those words like extensible, modular, hierarchical, but really something that’s built to scale, right? Because that’s the world we’re in. There’s no world where the products are static. So you really need to have this ability where as they come up like this infertility, man a direction that’s coming up right now from the from CMS. It’s not like a gosh, what are we gonna do about this? It’s like a sure, we got it. We know our product taxonomy. We know roughly where to put these and we already sort of roughly know where the impacts are gonna be downstream. Like this is new accumulators. We need this is gonna impact these documents, right? And I do think that while it takes a village, right, it kind of lives with product, at least understanding where all those tentacles are, where those impacts are gonna be, so that when decisions are made, it’s a more efficient process to get them implemented, which kind of leads me to kind of like the last step in the puzzle. And then we’ll kind of open it up to questions because this has been, this has been a great conversation. And I hope that the folks listening we’re trying to both talk about the friction points, but then also what are we seeing to solve those?

14

The Last Mile: From Sale to Claims

42:05
MMMargaret Medlin

So when I think about the last step in the food chain here, now I’m actually talking about the sales process was successful, right? We’ve sold that. And then there’s that last mile of getting it into the downstream systems, your core admin systems reporting systems, etc., customer service and to be honest with our customers like it’s the two bookends, right? When it comes to like the sales quoting process, it’s how can we make the that sales enablement experience much faster and seamless and more guided for brokers and sales folks as well. But then once it’s sold, how can we get that data downstream as seamlessly as possible? And what we most often hear is, and this is actually Brian going into what you said, is when you don’t get pretty clear requirements of what to even put in the quote, that’s why your quoting process takes a lot much longer. Well, the same exact thing happens is when you go downstream where now you’ve sold it. But let’s be honest, the amount of data that you needed to price and quote and sell is a fraction of what the claim system needs. I always use the iceberg like it’s the tip of the iceberg is what sales needs and then the rest of it is what claims needs, right? So most of our customers, what they’ll tell us is that process is weeks and weeks of back and forth, back and forth conversations with the salesperson, reading the sales paperwork trying to interpret what was sold and then trying to basically now understand what the core admin system actually can accept. So for both of you and Annie, maybe I’ll start with you. How are you guys are, is that last mile that step right? Is that something that you are personally focusing on or just the entire general where do you guys think that some of the transformation might need to happen on there? Yeah, I think definitely to your point, it’s all about making sure you have clear communication.

AAAnnie Alexander

What we’ve been talking about. We actually engage our operations team as part of our quoting because we want to make sure that they’re in line with what we’re selling. So we, that’s part of our review and approval process because we do not want to sell something that we cannot operationalize. So we make sure to engage our operations team who will actually be building the benefits and administering like all of the things like that’s part of our review process, but there’s always misinterpretations and clarifications that you need and things like that. But it’s also making sure that we’ve got a good support internally. So we have someone to navigate with the team, right? So for really large implementations, we have a dedicated PM to help us navigate, have clear expectations on who’s on base, what we’re doing when we have to do it by what kind of communication we need for our customers, making sure that they are understand where we’re at if we’re hit any roadblocks. So I think it’s really just making sure you have good communication, you’re organized, you have your things to do and you should know every piece of the puzzle, the person that’s engaged, they know they’re piece of the puzzle. So getting the right SME’s around the table to make sure you have a good implementation, but I think really just trying to have as much as information as you can upfront during that sales cycle. So that way you have a good implementation is key.

MMMargaret Medlin

Well, I love the fact that you’re bringing them in earlier and that you have a quarterback especially for the bigger deals. Yeah, because they can get so complicated. And I’m curious when you do bring them in, do you guys already know, I guess you must know when a group is asking for something that’s probably a little unusual, that’s probably your threshold of let’s bring these guys in at this point, right? Yeah.

AAAnnie Alexander

Because we wouldn’t want to bother operations just for co-pay changes and things like that, right. But yeah, we have a threshold of this is OK and this needs further review. So then that way we make sure that we’re all on the same page. And then sometimes it is negotiation, right? Because we do tend to want to do perhaps the easier thing. And just because it’s hard doesn’t also mean that we can’t do it, right? So there’s just a balance of OK, but we can do it. And if we agree to do it, what does that mean? Does that mean a longer implementation? Do we have to level set with the expectations? Do we? But most importantly, can we stabilize it? Is it going to be trustworthy? Can it still produce something quality? Because that’s the biggest thing. So sometimes the compromises, we can do it, but it needs more time, right. And if you’re willing for the time to still get the quality, then that’s on the table. If they are all about speed and we just need something that then we have to also level set on, OK, well, this is what we can do. And without compromising what you’re going to get in the end?

MMMargaret Medlin

Yeah, back to putting personalization, giving them options. I think that’s what people crave. Again, I think every group is different, but honestly, like you’re the experts in what’s a successful product both from a pricing perspective, but also just from an administration perspective and a clinical perspective and a quality perspective. So really I think when you guys can share that expertise with them, ’cause you’ve got so much claims data over your years, right? That if you can activate that claims data to help you even drive some of your better product strategies and then you’re giving them proof points, right? Like, listen, you’ve asked us for this. Listen, we can do this. It’s actually even better for you. And we’ve seen utilization for groups like you do XYZ, right? I think those are some of the really exciting places that we’ve heard and that we are working on helping folks get into Brian. I’ll, Annie, that’s a great answer. Brian, anything to add to what you’ve seen at Kaiser?

BHBrian Hunter

No, I would say very similar approach, right. All the notes that she get there. The only thing I think I may add is there’s specific services that would trigger that type of level of engagement and clarification and management. There is some I would say market segmentation around that. It’s as you get to these larger and more customized strategic self funded it’s almost the default that you want to engage at that level. Not just because I would say as a customer, they’re much more interested at that level of detail than maybe a more typical large group that doesn’t right. Or they’re kind of doing it via broker that isn’t going to get into a definition at CPT level or something of a benefit. Whereas an ASO group may have been interested in going to that level of detail. So it’s a different group bringing in, so very similar.

AAAnnie Alexander

Oh yeah. Oh yeah, we’re working. We have clients who with our tool where you can do yourselves configuration within the guardrails. They do need us to open up for ASOs to the CPT level because they’ll want to go in and nitty gritty them out. So that’s definitely a need.

15

Q&A: Change Management

49:12
MMMargaret Medlin

Well, listen, this has been fantastic. I know we only have 10 minutes left, So gosh, this is fast. I want to make sure I can turn it over and get some questions from the chat. So let’s see, Chris, if you could help us out, have there been any questions coming in through the chat?

AHHost

Yes, certainly. Thank you. So let’s address some of them now. I’ll read you the 1st. It’s what are some of the change management issues plans are facing with this type of transformation?

MMMargaret Medlin

Yeah, I think we’ve touched on a few of them, but Brian, I’ll start with you. Any of the again, big ticket items that you think are some of the main change management issues you guys are facing.

BHBrian Hunter

I think we talked a lot about the new implementation of things you can’t forget about your day job and keeping the lights on, which is the other piece. That’s hard, right? So change management isn’t just bringing people along, showing them the vision, engaging them. It’s also how do you manage that often with similar staff who are currently doing the work in another system? What’s the run out. Around that? Not only operationally, but also from a technical perspective. And I think those are some of the big pieces that we didn’t go super in depth on, but those are definitely things that’s a good point.

MMMargaret Medlin

Resource capacity. So we do get asked that quite a bit as well is what is the resource needs from our customers during our implementations. And obviously there’s spikes where during requirements and then during UAT, right, and then training and roll out. And it depends, right, because a lot of everybody does their day jobs. And so there’s been occasions with some of the really larger companies we’ve worked with where they’ll make sure during certain busier times of the year, if the transformation is happening in parallel, which it usually is, right, is if they can actually find sort of temp resources that can handle the business as usual. They’ll even plan for that ahead of time, right, to say, listen, we’re just going to bring in a few people that will handle the business as usual so that our people can devote the time and energy it takes to some of these future state things otherwise the future never comes. But yeah, that was a great question. Any other items to add for your from change management aspect?

AAAnnie Alexander

Nope, I think that says it all. I would say it’s a good point about resources because that’s always a strain, especially with a big implementation or change So yes, absolutely.

16

Q&A: When Things Go Wrong

51:56
AHHost

All right, on to the next question is asking how do you handle situations when after the sale and you have configured a client’s benefits and find out after claims are processing that benefits are processing different than what they had prior to TPA. They give an example of deductible is supposed to be waived on certain benefits and the client’s former documents didn’t identify such nuances.

MMMargaret Medlin

Well, I can tell you what I’ve seen from other customers, but to be honest, I don’t work at health plans. All my experiences from talking to all the health plans. So Brian or Annie do either you want me to take that first?

AAAnnie Alexander

First of all, that never happens. What are you guys talking about that idea exactly. I was my response too, but no, right. It definitely is going to happen. I guess I would just say no one’s perfect. Things are going to get missed. And really it’s about how you recover when things go wrong, right? Things are eventually you’re inevitably are going to go wrong sometimes. So I think it’s about how reactive are you? Like, how quick are you to understand what caused the issue, what the root cause is and what, how can we fix it? And to have good communication with your customers too, to say we found this, we make it right and just say we’re on it. It’s our top priority. This is what happened. And just, it’s really about customer recovery at that point, because things are inevitably going to happen sometimes. And I think it means a lot to people when you’re straightforward with them and that they understand that you’re doing your best and that you will move mountains to make it right. And that’s what it’s about. I think I tell my team all the time, it’s not about being perfect. It’s about how you recover when things go wrong. And that’s really I would say the best way to maneuver it because it’s going to happen. It’s inevitable. But I don’t know, Brian, maybe you’re batting 100 over there. Like you got no issues over there.

BHBrian Hunter

So no, I think it was well stated. I think what to me, it’s part of that answer is like that whole iceberg effect. I was saying it’s because it’s true, like the sales people don’t want all the details and the nitty gritty in their paperwork, right? So even when we’re creating like these modular products with these guard rails, we’re still only showing a fraction of the whole product to the quoting experience for our customers, right? Because otherwise they’re just, you’d never get through the quoting process, right. So it’s inevitable that some of the details about like does this deductible apply on this very specific benefit example might not have been included in the part of the paperwork that was shown to the group. However, when you’re really looking at that end to end where that sole plan has to get in implemented into your core admin, what we’ll do with customers is we’ll say we need to build out the whole iceberg for you. So that means that there’s just a cascading effect and all those business rules around when a deductible applies doesn’t apply because you’re going to have standard ones going out of the out of the gate, right? All those get baked into to the to that product catalog, right with all those business rules. So you have your default set up what your standards are based on criteria like if it’s fully insured this state that yadda. So you’ll have all those guardrails and those defaults baked in, and then this idea that what you’re looking for is that you’re not silent about anything, right? It might not be exposed to the sales, people in the group, but before you go live with this, you all have signed off that this is how the product works, right? This is how it should be adjudicated. So that might alleviate some of those mistakes from happening because you weren’t silent about it, right? You are then passing all of those very nitty gritty details downstream still though, right? You might get a group that says, well, you didn’t tell me that the deductible didn’t apply in this case. And it wasn’t on my paperwork. And it’s like, well, yeah, because it was like a really tiny benefit. They still might want you to change it, right? But I would say that is one thing that we’ve seen is when you’re trying to do this full transformation is, yes, you need to focus on what sales needs to change. But then you’ve got to build out sort of that full iceberg of what your standard products are and how the rules cascade so that they’re not reinterpreted and rekeyed in every single time downstream.

17

Q&A: Freeing People for Higher-Value Work

56:34
AHHost

All right, we can probably squeeze in this last question here. They’re asking if you could talk about some positive impacts it has had in terms of your staff moving from data work to supporting key business needs. Meaning like that idea of like how many people, if you can take them out of doing manual rekeying of data how many people have been able to like successfully move into something that’s more like business value impact. I’ll open that up to both of you guys.

BHBrian Hunter

Yeah, I we’ve had pockets of that, right? It’s not that we’re perfect or anything like that, but where we have seen that and been able to get people out of creating by hand a regulatory form or something like that, right. It’s a different line of business more on the ACA side of it. But some of the automation that we’ve had around some regulatory filings and things and seeing some success there, you’re able to pull them up and share that knowledge in a more constructive way with products or with other areas and making sure that knowledge that they have at that level of detail is used and it’s informing things about what’s possible, what’s not possible. So it becomes a more proactive thing rather than spending their day managing spreadsheets and punching that in which has paid off and instances where we’ve seen that seems to have a much higher satisfaction and improved accuracy too. But even because you fix the input, you have better information that’s more informed and then removing manual pieces. Yeah.

AAAnnie Alexander

And I think, Brian, to your point too, just celebrating the wins, right. And so even though no matter how small they are, it’s a win. And I think that just pumps up everybody to like, OK, we’re going, we can do it. We can do it. So I think just making sure you celebrate the wins. Transformation is hard and it takes a village, like Margaret said earlier. And so just keep positive keep your eye on the prize, celebrate the wins with your team. And it’s a journey. So don’t give up. You got to keep going right.

18

Closing

58:46
MMMargaret Medlin

Well, thank you guys both so much, Brian, Annie, really appreciate you spending the time today with us and sharing all of your expertise with the crowd here. Really appreciate it. It’s been fun. I wanted to just let everybody know again, they’ll send out the link to the recording. You’ll also get my e-mail address. So happy to funnel any questions if you have any after the fact. Just reach out to me and any of you that will be joining the AHIP conference next week in Vegas, I’ll be there. So again please reach out. Love to connect you with in person as well. Thank you again so much for your time. Really appreciate it. Have a great rest of your day. Thanks everybody. Bye. Thanks all. Bye.

AHHost

Thanks to our speakers. Thank you so much for that great presentation and for sharing your thoughts. And thank you to the audience for participating in today’s webinar. This does conclude today’s presentation. Thanks again and enjoy the rest of your day.

— End of transcript —
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