Health care benefit service providers have invested billions of dollars in setting up and updating systems that can process claims.
Unfortunately, few traditional systems can communicate directly with flexible spending accounts, health reimbursement arrangements, health savings accounts or other next-generation consumer-directed health plan payment vehicles.
The older legacy systems–and many relatively new legacy systems–do not have the capacity to integrate real-time claim and CDH payment processing for patients, health care providers, benefits providers and financial institutions. The practical result is that many CDH plan members end up feeling as if they are trying to steer a car using traffic information that’s at least 2 weeks old.
Benefit plan administrators could address this problem by building and customizing new software, just as motorists could address shortcomings in automobiles by building and customizing their own cars. In reality, integrating a pre-built CDH platform into the existing claim systems is bound to save time and money.
This issue is important to benefits brokers, group insurance manufacturers and plan administration firms because the fate of the CDH movement will depend partly on how quickly and how well CDH plans can give members feedback about the true out-of-pocket costs of health care.
Consider XYZ Insurance Services, a hypothetical claims processing firm.
Use an outside, soup-to-nuts CDH vendor. That might make life simpler in some ways, but it would force XYZ to depend on the vendor’s vision of how a CDH system ought to work and how well it ought to perform.
Develop custom software. Of course, the project might take longer than expected and cost more, and many custom software development projects fail completely.
Use a commercial CDH system.
What are some of the ways XYZ Insurance Services could evaluate the alternatives? XYZ could, and probably should:
1. Hire an outside consulting firm to look at the options and develop a request for proposals.