BlockChain Healthcare Customer Centric

Who Is The Health Blockchain Customer?

In Health Blockchain Detroit, who exactly is the customer? Moving swiftly into BlockChain decisions without thinking about the ultimate customer will limit the potential of Health Blockchain.

Moving too fast will lock industries, employers, providers, and customer into systems with barriers to entry. There are two options in health Blockchain. First, continue the industry and practice silos we have today. Or, second, create a future state that is built for the customer.

Seeing the future through the eyes of the customer means challenging the silos in existence today. Silos will have the opportunity to protect and maintain their existence by using BlockChain. Is that what is needed? The alternative is to rethink the end-to-end delivery of not only healthcare but how information and health exist.

Autonomous Car Is To Blockchain

Blockchain disruption for business and customers are the same disruption everyone can see coming with automotive design. The autonomous car future for drivers and passengers of automobiles is what blockchain is to customers.

Visually, most conversations occurring around “driverless transportation” is easy to see. If you drive you can easily see the concerns and opportunities of building the future of transportation.

Keeping to the analogy of automotive disruption, I’d suggest people can not see the Blockchain disruption like they can see the future of transportation. I’m not sure most people think about what it takes to put unlimited funds on a healthcare card, just a simple example. Financial transactions are obscure, everyone uses financial transactions but the “roads” and maps connecting accounts behind the scenes are not obvious like the roads we ride on or drive on. While using a bank account and a healthcare card are familiar to people, most people don’t understand the transactions that make those cards work.

Turning left on a road when you drive will be duplicated by autonomous cars, you can immediately understand some of the complexity in doing that because it’s quite a visual event. Of course, the programming itself is another story altogether. But, anyone who has ridden in a car can appreciate and perceive the challenges ahead for automating this activity.

But, making the transactions for financial service is hard for many to perceive because they’ve not been involved in the transactional nature of the healthcare card, their ATM withdrawal, or other financial transactions.

Play It Safe?

Healthcare Blockchain is one idea, the entire Blockchain may indeed be much more inclusive of other transactions. The question is, can we use Blockchain to improve the customer experience? Or, will we simply duplicate the silos in existence today?

I suppose same-old-same-old is practical, duplicating silos because it’s safe. But, what if we can we turn upside down business practices and economics to give customers the upper hand in transactions? Blockchain will, or may, rearrange the economic advantage and redistribute leverage to the individual. That is to each of us.

Don, What Are you Talking About?

Health blockchain is simple. It proposes an internet security level never seen before, it proposes to use that security to trade money like bitcoin, but it also can include a contract that goes with the financial transaction. Simple, really simple.

Contracts are traded with the financial transaction avoiding the disconnect between financial transaction flow and contract flow. Blockchain makes ridged controls that eliminate tampering or changing contracts without others knowing.

What if you personally would benefit from blockchain? The laws of economics could be rewritten. No, I’m not kidding, economics can now be rearranged putting humans at the front of the engine riding behind the industry engine. Sounds crazy but it’s not? The point of having a Detroit Health BlockChain meeting is to demonstrate this phenomenon in a universal way. To engage the discussion across silos and examine what the future state could be.

Let’s Look At One Programmer, Developer View of Blockchain

The developer whose image is in the background (below) proposes a solution that is centric to their silo (any developer would reflect the same business idea), their way of monetizing their world, that’s what I call silo. I use this image but you will find something similar on any programming, developer, site. That’s fine for them, isn’t it? After all, what’s wrong with the way they paint the future?

The background in the image below shows how a developer perceives blockchain. They show banking and financial markets as a silo, insurance, retail and customer goods, government, and others as silos they can support and create using their Blockchain. Notice, it will be their Blockchain.

But stop a minute, ask, are they correct? Blockchain can be way more than recreating silos that match today’s business structures. The current state of business is what this tech company proposes as solutions. Even my title of Healthcare Blockchain proposes the same. But, is this the future state we want when the current state we know has flaws? You see, Blockchain has the ability to create a future, unlike our current state. But, leaders of thought, movers and shakers are going to have to understand other silos and engage in current state discussions to determine how Blockchain future will look.

Get a Glimpse of the Future By Looking at the Past

The old adage, “if you keep doing what you’ve always done, you’ll get what you’ve always gotten.” Or, Einstein’s, “Insanity is doing the same thing over and over again and expecting different results.”

The distributive nature of health Blockchain means alignment between and in silos can change to better serve customers. We know it can change, we know but is there any momentum to change? If there is momentum to change, where will it come from? Silos that exist today, or customers who have the most to gain? Change is something we have to choose, the future is ours to design. This is an economic do-over.

This is not a pie-in-the-sky notion, this is right in front of us. Answer this question, please.

Do you build the roof before the foundation?

It’s another analogy to convey we are at the beginning, and now is the time to lay the foundation, to review the current and create the future, not in a selfish way, but in a meaningful way, let’s build Blockchain as the new future.

What is starting to form around blockchain are answers before we’ve determined the questions that need the answering. Developers, like the example image above, are designing the future without public discussion on something as obvious as, who is the customer?

Is your silo even part of the discussion? What happens if you come late to the discussion?

Where are Customers and Contracts Connected?

If I had to pick the direction, I’d use my own 30 years of operational experience that spans money and contracts of all kinds: HR, payroll, taxes, government reporting, healthcare coverage, healthcare payments, provider (hospital, physician, pharma, etc.) fees, rebates, and other forms of healthcare payments, plus 401k plan payroll transactions, deferred compensation, individual IRA’s, banking, annuities and all kinds of contracts and transactions. This history (like your history) only tells me, us, there’s an opportunity to do better for customers. It doesn’t give me, or you, the answer to how.

What’s obvious is silos exist as barriers to understanding what’s possible for customer value, and at the same time, the opportunity to improve the customer value by shaping a better future.

Who is Customer?

Now that’s simple. You. Each of us. Our families, our communities, the US, the globe. No, really, this is simply the fact of Blockchain at its greatest boundary.

You will be a customer of Blockchain, so, start asking questions about what you want for yourself in retirement for instance? What financial transaction and contract would you like to see secured for your future? Medicare? Social Security?

Why, Health Blockchain Detroit?

I believe identifying the current state in healthcare will get a solid conversation going that is needed. The goal is an open forum to engage you in discussions that matter. The opportunity for changing the dynamic from a current state to a future state should not lose out to silos.

Healthcare Blockchain can rearrange economics and give us a chance to break with the status quo. Yes, this is an “eat the elephant” idea meeting.

But, as I see it, 8% of people are thought leaders, early adopters and change agents. I’m seeing this as a chance to get that group together now.

together we’ll discuss these Questions

  • Who is the Customer of health blockchain Detroit?
  • Should we join in an existing blockchain network or create our own?
  • What current business processes could most benefit from blockchain?
  • What existing technical approaches to moving and integrating data into or out of a blockchain will be relevant to our use cases?
  • Who are our technology and business partners, and how can we convince them to support a blockchain initiative to transform or even eliminate a given process?
  • What is the current state of processes and how does your silo/operation fit in?
  • What future state is possible?

Source: some questions were obtained from IBM.com, https://www-01.ibm.com/common/ssi/cgi-bin/ssialias?htmlfid=KU912407USEN, Link dated 9/11/2018.

Register your interest here for health blockchain Detroit, I will continue to develop interest and find a venue, speakers, and sponsors. Feel free to be involved in any way you please.

Huffington Post Article – Healthcare Buyers Advocate

A previous article for the Huffington Post is still very relevant today.

Here is the introduction and link to the remainder of the article.

The Top Four Reasons Owners Need A Healthcare Buyer’s Advocate

Compensation, healthcare & employee benefits are often significant sources of frustration for business owners. By the end of this article, you’ll see that finding your own buyer’s advocate is not only a good idea; but, a necessity.

Having a knowledgeable and experienced team who advocates for you and not for the insurance company will reduce your stress level, save you money and time.
Don Watza, Huffington Post Article 

https://www.huffingtonpost.com/don-watza/the-top-four-reasons-owne_b_8039958.html

There is a new service called independent evaluators that focuses on helping business owners and their employees. This new service changes the purchase paradigm by offering a business owner their own buyer’s advocate. A good advocate puts control in the owner’s hands, giving them back control they may have inadvertently given away.

Here are the top four reasons to consider a healthcare buyer’s advocate:

https://www.huffingtonpost.com/don-watza/the-top-four-reasons-owne_b_8039958.html

Purchasing Stop-loss Insurance for your Self-funded Plan Requires An Expert

Consider the following questions:

Do you have an employee benefit plan that you self-fund?

Are you responsible for purchasing stop-loss coverage to protect your employer interests?

Is your broker experienced with hundreds of cases that provide you comfort they know what they’re doing?

Are you a broker who is trusted by a client but need an expert to help you keep that trust?

Is the person purchasing stop-loss for your business relying upon an inexperienced agent, broker, or consultant to make the right recommendation? Continue reading “Purchasing Stop-loss Insurance for your Self-funded Plan Requires An Expert”

5 Reasons to Avoid Self Funding Your Health Plan

Bring balance to your decision making with an independent evaluation.
Bring balance to your decision making with an independent evaluation. www.DonWatza.com

Small Businesses are putting their businesses at serious risk

In talking with prospective employers one of the most popular topics that arise is self-funding. It being sold like it is the magic solution for employers. The fact is, it’s being sold because it’s an expedient way for carriers and group agents to “stay in the group market.” This means, by offering self funding as the preferred option to “save money” the agent can keep an employer in a “group” policy.

A group policy is much better for a group agent because they can maintain the employer relationship and write greater premium with one policy, the commission is greater too. It is much easier to sell the “popular” fad solution than to dig into the specific details of your plan. There is a large investment of time needed to do the best job comparing all the possible options.

Unfortunately, in the process to “win the sale” important facts about self-funding are left out. There are pitfalls to self funding no matter what your agent, consultant, carrier, TPA or administrator may say. Employers must consider the small print about self-funding before jumping in.

For larger employers, there are benefits to self-funding, but for a group of 25, 40 or 75 employees it is a bad idea. The proposed gain can easily be outweighed by an unexpected $1,000,000 unpaid claim.

Here’s a short list of reasons that should give a small business owner pause before self funding.

1 – Being an Insurance Company Isn’t On Your Bucket List

Being self funded means you move out from under the safety of having an insurance company paying claims. There’s the potential that you may have to pay claims when the TPA/administrator/insurer decides not to pay.

Not to mention, all the new rules and obligations.

2 – You Want to Buy Coverage, Not Be the Coverage

Here is a quote that most people would call the “small print.” You won’t find it in the typical sales material or presentation. You will find it when you’re asked to defend the non-payment in court.

“The participating employer agrees to be solely responsible for compliance with all laws, including the payment of any required benefits that are not covered as illustrated in the Summary Plan Description or the stop loss policy.”

Administrator Actual Policy Language

3 – You Become The Expert In Making This Decision

This carrier is being honest when they say, you should have experts telling you what to expect before you choose self-funding. This quote is a warning found in the sales material.

“While many employers can benefit from a self-funded plan, it may not be the right choice for every business. The biggest question a small group employer has to consider is if the additional risk will jeopardize their business.”

Administrator Advertising Materials

If you self-fund you will need a qualified person to evaluate your risk before making the decision. Your sales agent, consultant, insurer, CFO, HR person are not qualified to make this assessment. Will they pay the claim or will that come from you, the owners pocket?

This is a skill that is working for others every day why not ask for help after all, you hope people hire you for your expertise.

4 – You Didn’t Have Time to Read the Small Print

"If a material or fraudulent omission or misstatement is made in the application form, We have the right to deny any claim."
“If a material or fraudulent omission or misstatement is made in the application form, We have the right to deny any claim.”

The Big Print makes promises but the small print takes those promises away. When your self-funded administrator, TPA,insurer decides not to pay a claim, you’re on the hook. You as a business owner become the checkbook.

It’s true, in today’s sophisticated and complicated healthcare world it’s becoming more necessary to independently evaluate your options.

CAN YOU SAY DOUBLE TALK

This is just one example of the big print:

“Your maximum self-funding cost for the plan year is determined up front – and it’s guaranteed not to change, …

And here’s one example of the corresponding small print written into the policy of the carrier who published the “big print” quote above. There are many statements like this and you should know them all, or have someone who does.

  1. “We issued this coverage in reliance upon the accuracy and completeness of the information provided in the application form and during the enrollment process. If a material or fraudulent omission or misstatement is made in the application form, We have the right to deny any claim, rescind the coverage and/or modify the terms of the coverage or the premium amount.”

Actual policy language, page 1.

5 – You Didn’t Make a Benefit Plan to Tell Employees They Aren’t Covered

It happens, google the topic of “self-funded plans that couldn’t pay claims” and you will find 42 million website hits (graphic below).  The point is, there’s not shortage of problems for those who get in over their head.

Google search on self funded plans that couldn't pay claims.
Google search on self funded plans that couldn’t pay claims.

 

Do you Still Need Convincing?

Show me the options in front of you and I’ll show you the trouble.

Send any quote you have received and the comparisons I’ll give you my two cents for free.

This offer is available to owners only. Send them to my email without PHI, djwatza@gmail.com.

Source: Actual administrator and carrier language from marketing promotions and specimen policy.

A Real Life Story of Accepting ACA Changes for a Small Business; Part II

Part II – a Small Business Looking to Do Better

The story starts with a business who engaged us for our Decoder because they asked the simple question, “we know it’s different than it use to be, and we perceive we could do better but we don’t know how to make the right decision.” In the first post, a couple days ago, you learned about the background a little bit. Feel free to review that post below.

Today, we’ll begin to cover details about who is being covered and who is not. It’s very common to have employers who cover individuals that should not be covered. Would you be surprised to know that employers have been known to cover deceased employees, or family members? When we visit with employers we never expect problems but we’re never surprised to find them either.

Job One, Research

Our first job is to research the details about all those covered and all those who are, or were, working for a company. We ask for lists that would show us this information. For instance, tax statements that provide lists of employees and payroll reports that show hours worked plus HR rosters of employees and former employees and other data. The research starts almost immediately and it usually entails asking questions about documentation that’s available that an insurance company would ask to prove the status of an employee or dependent. Identifying problems can be as easy as doing this research.

Our research immediately draws our attention to questions about a former board president who is still covered. In asking questions, it’s obvious there is no current relationship with the former executive. They had been involved and were made promises by the company. As we discuss this with current ownership, no one wants to address the issue with the board or the former executive. We helped solve the problem by including a proper commentary about the liability to both parties for covering someone who should not be covered.

But the former executive had an agreement?

Insurance companies can audit large claims any time, that’s in the small print. If they audit a claim on a former executive, like in our story, and they discover this person is covered it would be bad for both the employer and former employee. Coverage for groups means employees of the group must be covered and individuals who are not employees can not be covered. This is why it’s called group coverage.

So what actually would happen?

If an audit were to occur by the insurance company they would deny the claim of the former employee stating they’re not an employee of the company and not eligible for “group” coverage.  This is bad because the former employee and covered individual could use promises by the government to impose upon the employer the need to pay the claim. To keep the story simple, I’ve eliminated all the details and possibilities for how this could happen. The point is, there’s a chance the employer would be stuck paying the claims of the employee without insurance coverage. This is bad for everyone.

When we arrived the former employee had been on the plan more than 10 years. Why this had been left to linger is anyone’s guess.

What was the outcome?

The employer and former employee understood the risk to both employer and former employee. We introduced an agent who could help with individual coverage. We directed them to seek individual coverage immediately. This was completed within a week. As a note about how this worked, ACA makes transition from group to individual possible because it eliminated pre-existing conditions and medical underwriting. In the old days, these two rules made doing what we did much more difficult.

This small adjustment to the rules gave us the understanding to help the employer. Because the Decoder puts all of these facts in writing, it made it much easier for the employer to make the change with confidence. They just had to see it in writing and be able to show the former employee as well. This is the purpose of the Decoder.

If you enjoyed the story, or learned something from it, please let me know in the comment below. Do you have your own insurance story?