“What is really important to us intermediaries is to trust the technology, claims tracking and loading of data, to free us up to consult,” says Karen Gamble, director of health and wellbeing at consultancy Heath Lambert Employee Benefits. When it comes to the technology proffered by healthcare trust providers, she believes one provider is “streets ahead” in delivering this service.
“Healix still haven’t got their system up and running, Bupa’s falls over with great regularity and AXA PPP healthcare is limited to loading of data,” she reports.
It’s a frank analysis of the market and a glowing endorsement for WPA, the aforementioned “streets ahead” performer.
“What is so very useful with WPA is the instant nature of everything,” Gamble explains. “Post is scanned and immediately available if there are any queries and claimants can track their own claims.”
Broadly speaking, Paul Brantingham of fellow intermediary i2 Healthcare agrees with her endorsement.
“We think WPA has very good systems with really good people,” he reports. “What is really useful to us is having access to insurers’ membership and claims systems. What we’d ideally like with all insurers is the ability to update membership records, obtain detailed claims analyses and to be able to choose how to ‘cut’ claims data.”
For Adrian Humphreys, managing director of corporate clients at WPA, the goal is to give brokers “everything that they require”. This may sound like the holy grail to intermediaries like Brantingham who want to be able to provide clients with very detailed break-downs of scheme performance.
“We are asking brokers, ‘what information do you want?’” says Humphreys. “What clients want is knowledge – what are our claims for? We will provide that in real time.”
Paul Moulton, sales and client relationship director at AXA PPP healthcare, understands the importance of management information but believes there is a balance to be struck with maintaining confidentiality. With the right letters of appointment both clients and intermediaries (“certainly for larger trusts”) can access information about claim spend online and Moulton believes that settling claims electronically with providers will speed up the reporting process.
Over at CIGNA HealthCare, marketing director Ann Dougan believes that the standard management information delivered to brokers already provides “a really good view on claims”. These reports can be published online in a client portal, where requests for additional information can also be made.
“Although standard publication of management information is quarterly some receive monthly information on top of that and ad hoc requests for information can come in at any time,” she says. “Because we have a data mining tool we can turn around brokers’ requests for additional information quickly and if we get lots of requests for a certain type of analysis we can add that into standard reports.”
According to Richard Saunders, sales director at Healix Health Services, the priority for his organisation to date has been developing case management services, of which more later. However, he reports that a “considerable investment” has been made in developing an online portal for members and brokers.
“When this goes live it will complement the personal case management already delivered by our nurses, providing membership updates and amendments, the facility to add or remove members as well as access to a wider range of reports in addition to the monthly claims reports we currently provide to our clients,” he says.
For Jan Lawson, chairman of Medical Care Direct (MCD), the company behind Health Link, a new healthcare trust available to organisations with as few as 100 members, there is still huge potential to be more transparent with brokers.
“We are a great deal more open than some of the insurers because they use the data protection act as a huge cloak to guard everything because they see it as commercially sensitive,” she says. “They think that if we keep brokers in the dark it will stop them being able to move a scheme elsewhere. In terms of providing people with information and giving them proper detail, as long as it does not breach strict medical confidentiality we will give very detailed claims information because I think it’s very important that both the broker and the client can check how the money is being spent.
“Some of the way claims reports are coming out from big insurers are so anonymised that it is very difficult for anyone to be confident that claims are being allocated directly.”
Health Link offers monthly reports but Lawson says that MCD would aim to provide additional information requested in the interim within 24 hours. She sympathises with brokers who have found that information on large claims is provided “late in the day”.
“You should be able to let an employer know if you have a claim just starting that looks like it is going to be particularly expensive,” she says. “It tends to be after the money has been spent. The cycle of information is quite difficult.”
Responding to criticism
It is this cycle of information that has caused some advisers to criticise Bupa’s online system.
“We can’t get a given month’s claims data until about the 8 of the month following, although the date varies,” reports one intermediary. “We also have ongoing concerns about data accuracy – it seems inconsistent and we have had instances of inaccurate claims reports.”
Linda Wallace, head of intermediary management at Bupa Health and Wellbeing, argues that SWIFT, the new computer system introduced in August 2009, has been “well received” in the market, but says changes have been made to reporting.
“To ensure the accuracy of our month end reporting, we reconcile our data against a number of checks and audits, and only distribute it once we are confident it is robust,” she says. “Implementing SWIFT has allowed us to complete these checks more quickly, meaning we now distribute month end claims data on the 8of each month, as opposed to on the 15 as we did previously.”
She adds that in March, in response to intermediary feedback, Bupa updated the way it distributes month end data.
“This upgrade further enhanced the clarity that SWIFT provides for intermediaries, and we are confident in the accuracy of our data,” she says. “Bupa is committed to providing robust data, and we work with brokers to ensure a prompt response to any concerns raised.”
Intercom, Bupa’s e-commerce tool, allows brokers to access claims reports online at any time and for more detailed data brokers are advised to contact their account manager. It also allows brokers to update membership records and access claims reports online at any time.
Simplyhealth has also had to respond to broker criticism about its systems. Howard Hughes, head of employer marketing at Simplyhealth, says that the organisation did experience technical problems following the creation of umbrella brand Simplyhealth.
“When we rebranded as Simplyhealth, we brought together the legacy systems of HSA, LHF, HealthSure and BCWA on an integrated platform,” he says. “This was specifically designed for the administration of health cash plans and private medical insurance and to coincide with the launch of Simplyhealth. It was set up to provide our people with the technology they needed to service our customers in the most efficient way. The Medisure and Remedi systems were excluded from this new system as it was recognised these needed to be kept separate, in order to meet the different requirements of our self funded health plan customers.
“We did experience difficulties with the launch of our new system which resulted in some disruption for our customers. Customer service is at the heart of what we do and we apologise for any disturbance caused. The great news is that we have since fixed these system problems, with customers now experiencing the high level of service they have come to expect from Simplyhealth and an improved and robust system for the future.”
Making changes online
The online offering provided by Simplyhealth includes MyPlan, a feature which allows group secretaries, and by default intermediaries, to gather reports on demand, update membership records online and, if you are a member, to access your own records.
Such interactive services are valued by intermediaries operating in the healthcare trust field where schemes typically cover a large, fluctuating membership, with employees joining, leaving and claiming throughout the year.
At CIGNA the emphasis is on providing secure portals where brokers granted permission by their client can act as administrators, making changes to schemes. Members also have access to a portal where they can view membership details, benefit entitlements and claims history. Different permission settings can be made to control who has access to what.
Meanwhile, WPA’s approach is to link directly to clients’ HR systems.
“We are co-terminus with their payroll system,” explains Humphreys. “If you leave the company you do not have to ring us up, we get notified automatically.”
In contrast to the bigger providers, Health Link does not currently enable brokers or members to make changes to the trust online. Lawson sites data security concerns as the main barrier but stresses that if a particular client wanted access a solution would be found.
“We are more than open to talk to them about their requirements,” she says. “If they have needs not being satisfied and we can find a way to satisfy them and get business then that is good for all of us.”
At AXA PPP healthcare, the focus is not only on enabling brokers (with permission) to make changes to schemes in real time, but to give members access to scheme information via extranets and intranets. Moulton believes this should not be limited to policy details.
“We have invested heavily in providing much more information and detail on health-related areas like fitness and nutrition,” he explains. “There is an education piece here.”
A similar approach has been adopted at Bupa where members of trusts can access a dedicated online portal containing their policy details, a search facility for Bupa-approved hospitals and consultants and health advice including interactive assessment tools.
While these resources meet the requirement for 24/7 access to information, brokers believe that access to providers’ people remains hugely important. Interestingly, both Gamble and Brantingham mentioned staff in the same breath as systems when reviewing providers’ services.
“WPA staff are really great, responsive, knowledgeable and they know who does what,” says Gamble. “We rarely have to wait while someone who might know what is going on is found. We just don’t get shoved from pillar to post.”
This seems to reflect Humphrey’s theory that technology frees up staff to focus on customer care.
“Ten years ago we employed lots of people who would sit there and pay 60 claims a day,” he says. “Their job was to take one lot of paper from one side to the other. Today 87% of claims are paid automatically, thanks to optical character recognition. Now we can employ people to spend time on the telephone with customers, acting like a personal PA, organising a cab for those having certain procedures for example.”
While he argues that the key to good customer service is to “go for good people and pay them really, really well”, Humphreys also believes that technology should “embrace” customers.
“Callers are under stress,” he explains. “We give our staff huge screens showing everything we know about that customer – for example, whether the specialist they have been referred charges beyond the fee schedule. This could mean that we liaise with the consultant’s secretary to negotiate the fee before calling the customer back. We are able to think ahead of the customer all the way.”
The benefits of automation also extend to WPA’s coffers.
“Claims are paid effectively automatically and more accurately than by a human being,” explains Humphreys. “Hundreds of checks are carried out that pick up duplicate claims and that is worth millions of pounds a year to us.”
Saunders share his belief in using technology to improve Healix’s service (which Gamble “loves”).
“Any member of a Healix Healthcare Trust needing assistance can talk to a person who has medical expertise, as well as access at their fingertips to both the case management and benefit information needed to ensure the right treatment is provided as quickly as possible,” he says. “This is a great example of the use of technology for healthcare trust management – case management and benefit entitlement are all included on the same system to give the Healix case managers all they need in one streamlined process. This, in turn, helps us ensure that an individual is offered treatment that their benefit entitlement will cover, as well as manage costs for the scheme provider. And, of course, any member who needs to find out the status of their case, entitlements, etc can contact their personal case manager.”
He may be encouraged to hear that while technology is valued, it is people that leave a lasting impression on brokers.