Let the experts be the experts
The industry keeps building one more front door. Members still get stuck in the back.
The industry keeps building one more front door. Members still get stuck in the back.
Most of the energy in health benefits goes to the front end. A new app. A new portal. A platform that promises to be everything to everyone, with every program behind one login.
It’s a reasonable goal. But members don’t struggle because they lack another front door. They struggle when what’s behind the door doesn’t line up: a claim that doesn’t match the account, a card that doesn’t match the plan, a rule one vendor applies and another doesn’t.
Platforms that try to aggregate everything run into the same wall. Each program has detailed nuances that took its specialist vendor years to get right. Flatten them into one system and those details get lost, or buried somewhere nobody can find them when it matters.
Take something as small as a name. A vendor’s file says John SMITH. The health plan’s system says JOHN Smith. To a person, it’s obviously the same member. To two systems matching on exact text, it’s two different people, and the claim, the card or the payment stalls. No amount of front-end education fixes that. It has to be fixed where the data meets.
We think the better answer is simpler. Let the experts be the experts. Keep the best vendor for each program, and orchestrate what happens between them: the rules, the files, the hand-offs. When the back end agrees, the front end feels seamless, whichever app the member opens.
It also gives plans something rare: freedom. When the connections between vendors are managed in one place, keeping a vendor or moving on is a business decision, not a rebuild.