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Life Health > Health Insurance > Your Practice

3 Things to Know About a Health Insurance Information Tamer

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Zipari Inc. tries to reduce health insurers’, and other health care system players’, need to think about their computers.

The Brooklyn, New York-based company has its computers pull data and rules from a corporate customer’s computers, or from other computers, then shampoos the information, combs it, conditions it, puts a bow on it, and uses automatic recommendation tools to push it out onto the right computer or mobile device screen, at just the right time.

Mark Nathan, the founder and chief executive officer of the Brooklyn, New York-based insurtech company would rather not talk about how much data his company has on its computers, or what kind of artificial intelligence algorithms it’s using to inhale and channel information, but about how well the system dashboards look and work.

A typical health insurer, for example, might have a customer service representative who has to log on to 20 to 30 different computers to help the customers.

“There’s a lot of things that are going on,” Nathan said last week in interview. “We get all of the data from all of the other processes.”

Zipari has other systems that aim to perform similar acts of data taming for health care providers, provider search directories, employers, health plan direct-to-consumer selling systems, and health plan broker portals.

Nathan himself earned a bachelor’s degree in electrical and computer engineering from the University of Colorado Boulder.

He started out working as a robotics engineer at NASA, from 1989 to 1993. He later moved out into private-sector technology jobs, with stints as director of professional services at Apple Computer Inc.; a technology executive at The Guardian Life Insurance Company of America; and chief technology officer at Freelancers Insurance Company.

In 2014, Nathan started Zipari, to improve health insurers’ data portals.

The company has raised about $40 million from investors through four rounds of financing, according to forms filed with the U.S. Securities and Exchange Commission.

(Related: Buoy Health, RecoveryOne and Zipari Attract Funding: Health Tech Deals)

The last round of funding included investments from the investment arms of CareFirst and Horizon Blue Cross  Blue Shield of New Jersey,

1. Most health insurers are still getting used to the idea of working directly with consumers.

For years, big health insurers sold coverage mainly to employer groups.

“They really didn’t have a reason to communicate with the consumers,” Nathan said.

Starting in 2014, the Affordable Care Act gave health insurers a chance to sell large amounts of coverage directly to individual consumers, by giving insurers a chance to sell coverage without a slow, painful medical underwriting process.

At that point, “they really did have a reason to communicate with consumers,” Nathan said.

2. The COVID-19 has highlighted the weaknesses in many health insurers’ consumer-facing computer systems.

This is a time when health insurers would like to get messages about benefits changes, and care recommendations, out to enrollees quickly, but “their existing systems are old,” Nathan said.

Although the insurers may have enrollee portals, “they don’t have a great relationship with the consumer,” Nathan said. “They can’t get the new messages out,”

Sending new message tailored to meet the needs of specific groups of enrollees is especially difficult, he said.

3. Solving the COVID-19 enrollee communication problem will help health insurers improve efforts to keep enrollees healthy and help patients with health problems manage their conditions.

Access to better recommendation tools could help plans tell enrollees about new COVID-19 testing benefits and telehealth benefits — and it could help health insurers use their giant stores of health care data to run ordinary health coaching programs, Nathan said.

Plans could use the messaging tools to send enrollees personally tailored alerts about what kinds of preventive tests to get, to improve the enrollees’ health, and also to improve plan quality ratings, Nathan said.

“Health plans are starting to see the value of that,” Nathan said.

Nathan said one key to getting the right information to the right people at the right time is to understand what different groups of users might want.

Consumers, for example, might want general information about the plans, and they may also want fine details, such as precise lists of the drugs and providers a plan covers, Nathan said.

Group brokers may have many of the key plan details memorized, and their information priorities may quick access to quotes and employer employee census upload tools, Nathan said.

He said agents who work with individual clients might need quick access to the kinds of details that interest individual consumers, Nathan said.

— Read COVID-19 Will Speed Up Insurer Tech Upgrades: Majesco CEOon ThinkAdvisor.

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NOT FOR REPRINT

© 2024 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.