It’s no surprise that healthcare costs are rising, and as a result more employers are considering a concept called, Reference Based Pricing (RBP). While RBP has been around for several years, it’s still a relatively new solution. And with anything new that requires a change in thinking for employers, employees and healthcare providers there can be challenges that come with the rewards of reduced cost and greater transparency. In this podcast, John O’Connor, Partner and Vice President of 44Noth, shares what Reference Based Pricing is, the rewards and the risks associated with implementing this strategy.

Welcome everyone to Episode 2 of our Channel44 Podcast! Today, we are talking HRIS systems. HRIS stands for Human Resource Information Systems. Three of 44North’s in-house experts discuss 5 tips when looking for an HRIS System. Brigitte Sloat is an Account Executive and Kelly Dent and Alicia Starkey are our Online Experience Team Leads.

Tip 1: Identify and prioritize your needs.

• When you say HRIS, it can mean different things to different people. To some it is a benefits administration platform, to others it’s Payroll and Ben Admin, to others it could also include time and attendance, etc.
  • And depending on what you need, what is the most important.
  • Pull together a team/committee, getting input from every area of your organization that will be impacted (Especially finance) and create a scorecard for the vetting process.

Tip 2: Ask the right questions.

• We’ve worked with multiple systems and with vendors who looked good on surface but deeper questions revealed more.
  • Example. Don’t ask yes or no questions. Can the system do ______? Is a yes or no question. How does the system do ________? Or Show me what it looks like when the system does ________. Are better questions to ask.
  • Are you and the vendors you’re talking to speaking the same language? You may have one version in your mind and the vendor may think you’re asking something else. Having them explain how or show you how can quickly reveal if you’re not on the same page.

Tip 3: If you have an existing system, don’t assume issues are always a limitation of the system.

• We’ve heard employers complain that a system is not working or they’re frustrated that the system has limitations. We know the system is capable to do what they need, but the reason it’s not doing what’s needed is because it was programmed incorrectly.
  • Not all partners or service/implementation teams are created equal, whether through a third party or the software vendor itself.
  • If you’re thinking of replacing an existing system, you might want to interview another provider of that system to make sure you’re not going through a system change if you just need a system tweak.
  • That’s another question you should be asking is what does service look like after implementation. Are you going to be interacting with a ticketing system or are you going to have a live person who can help you manage ongoing.

Tip 4: 1 Size Fits All = 1 Size Fits None

• It’s easy to be sold on a system that can do “everything”.
  • In systems that combine multiple HR functions, they probably do 1 thing really well and the others are add-ons.
  • Example. A payroll software company that adds on benefit admin and then adds on time and attendance, etc. Chances are they’re good on payroll but probably not as strong as the others.
  • You’ll also find that sometimes behind the scenes it’s not all one system but multiple systems connected to each other.
  • Not necessarily bad, just be aware and as you’re evaluating between different systems take note of which ones are stronger in which areas and align those with what’s most important to you.

Tip 5: Always check references

• Good practice for any vetting process.
  • Ask vendors for references with multiple years of experience with the system.
  • Seek reviews through external sources like your benefits broker, other HR professionals and association contacts
  • Ask for at least 1 negative reference or 1 challenge. There is no perfect system. Make sure you can live with its imperfections.

There is so much that goes into making a decision on new technology that should ultimately create a better experience for employees and organizations. We hope these tips are a good start to that process. If you have any questions for our team about this topic or any of our other podcast topics, please email us at [email protected] .

Congratulations! You just completed your annual employee benefits renewal. Whether you made benefit changes or renewed as is, a new benefit year always comes with questions and issues. You prepared employees with an awesome open enrollment presentation, beautifully designed brochure, and a convenient online portal/app. Now your employee and their dependents are all alone at the doctor’s office, pharmacy counter, or opening that bill at home and something isn’t right.

Don’t panic. We asked our team of 24/7 Patient Advocates to share the most common issues employees experience, and how to resolve them. Here’s what they shared:

1. You’re not covered. When a provider or pharmacist tells you you’re not covered, this could be for a variety of reasons. Within the healthcare and insurance industry, there is an immense amount of data flowing between your enrollment process, your insurer and the provider/pharmacy, and there is no such thing as a perfect system.

If your provider isn’t finding your coverage, the first thing to ask is if they are using your current insurance information. When you give your provider your insurance information, they store it in their system. That’s why you don’t have to show your card at every visit. If you receive a new card from your insurer, be sure to show your new card at your very next visit.

Did you know that at some pharmacies, your insurance information could be tied all the way down to the individual prescriptions you’re filling? This means even if your information is updated for your overall account, the old insurance information could still mistakenly be used to bill your individual prescriptions.

“One of our members was standing in line at the pharmacy on a Friday afternoon and were being told that they had no coverage for the maintenance medication they’d been taking for years. This was right after the new year and majority of the calls like this mean the pharmacy has old insurance information. I asked the member to hand their phone to the pharmacist so I could help. Even though the member had given the pharmacist their new card, we were able to determine there was still a place within the pharmacy’s system with the old data. It only took a few minutes to get the member on their way with their prescription in hand and paying their normal copay. Even so, I know these can be stressful situations when you’re standing in line and everyone behind you is waiting. I recommend contacting your provider/pharmacy before your next visit to give them your new information over the phone so there are no surprises when you’re standing in line. If something doesn’t seem right, you have time to get it resolved.” – Samantha, 44North Patient Advocate

2. Coordination of Benefits. Employees and their dependents may have access to a variety of insurance coverage sources. The benefits you provide as their employer, their spouse’s employer plan, Medicaid, Medicare, and Tricare are some of their options depending on their specific situation. They all need to know about each other and know their place in the order of who pays. Even if your employee has no other coverage to coordinate with, your insurer needs to know. Just as with #1 above, there is a lot of data flowing between all these parties, and if there is any breakdown in communication it can cause issues.

“A member received a bill for over $46,000. Understandably he called in a panic. When I contacted their insurer, I discovered the claim had originally been paid, but the payment was pulled back, because the member hadn’t updated their coordination of benefits information with them indicating they no longer had other coverage. I helped the member through the process to update the Coordination of Benefits information with the carrier. The claim was then processed correctly, and the member only owed $540.

Even when the Coordination of Benefits information is correct, when there are multiple payors it can sometimes take a while for the claim to go through each of their billing departments. When members receive a large bill from their provider in the mail, I recommend they check the date of the invoice. If it is less than 30 days from the date of service and they don’t see payments from all their carriers, they should disregard that statement and wait for their Explanation of Benefits or the next billing statement from their provider.” – Niki, 44North Patient Advocate

3. Preventive v Diagnostic Benefit. When the Affordable Care Act required plans to start covering preventive services with no charge to members, it created another layer in the health insurance claims process. Everything in the claims process is based on codes, and there are over 100,000 codes to choose from. What you thought was a simple office visit equated to 10 different codes in the billing process. As with #1 and #2 above, there is a lot of data flowing between the provider and your insurer. Not only do those 10 codes need to be billed, but the order they are billed in could impact how the claim is paid. We all know preventive services should be at no cost to the member, but sometimes the preventive code that tells the insurer to eliminate member cost share gets lost in the mix.

“My members commonly get billed for preventive mammograms and colonoscopies. Even though it’s a common occurrence to me, it’s stressful for them when they think they have an unexpected cost. I’m just glad they know to call me for help, instead of paying it. It’s a quick fix by contacting the provider and the insurer. I advise my members if they think they are having a routine preventive exam to ask during the visit if any of the tests or procedures being done are not preventive. Then they know what to expect when their bill comes, and if it’s not what they expect then they shouldn’t pay.” – Chris, 44North Patient Advocate

4. Billing Errors. Between 30% and 80% of medical bills contain errors, and an audit by Equifax found that for hospital bills totaling $10,000 or more, there was an average error of $1,300. How does that happen? At the risk of sounding like a broken record, there is so much data flowing through the healthcare and insurance industries that it’s more of a surprise when things go right. What’s the average lay person supposed to do? As the proverb goes, “The best defense is a good offense.”

“I worked in the healthcare provider side of the industry and the insurance side. I’ve worked a lot with Medicaid policies as well as commercial insurance. I tell patients and members never to assume anything is covered or how it’s covered. Test the system before anything is done by requesting a prior authorization, and make sure you document everything. Billing errors happen all the time, but when you have that prior authorization documented it’s easier to get fixed.” – Danielle, 44North Patient Advocate

When employee benefits is one of the largest items on your balance sheet and is a critical component to recruiting and retaining top talent, it’s key to maintain the integrity of what you’re providing. A breakdown in any part of the system could leave employee’s feeling their benefits aren’t really a benefit. In addition to being an informed healthcare consumer, ideally you also have access to a benefits professional 24/7 to navigate and resolve benefit issues on your behalf.