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Benefit Management Technology Taking an Autonomous Car Approach

By Doug Wilkens

SKYGENUSA Powering Healthcare for the Digital Age


You would pretty much have to spend the last couple of years alone on a tropical island to not be aware of the impending revolution being brought on by the so-called “autonomous car.” In the next few years, major automakers and tech giants such as Google and Microsoft are saying they will be putting cars on the road that completely automate the process of getting from here to there.

No drivers needed – just tell the car where you want to go and it will take you there. It promises to be a game-changer.

Similar innovations are now coming to benefit management. Processes such as those required for claims handling are quickly moving from being performed by an army of people to an automated (driverless) approach. These technologies put the brakes on costs and the benefits administration burden for payers and providers while accelerating resolution.

Here are some of the most exciting innovations to get your motor running.

Benefit management at the micro level


Benefit plan structure typically followed the old Henry Ford quote “You can have a model T in any color you want, as long as it’s black.”

Today, technology-driven benefit management solutions make it possible to set different benefit levels within a plan based on varying characteristics of the participants. One significant example is automating the delivery of dental benefits to dependent children of members (up to the age of 18) even when their parents don’t have dental coverage. This capability is required to meet the Essential Health Benefits provisions of the Affordable Care Act so commercial plans can be listed in the exchanges.

Payers can now break things out based on a wide variety of parameters, such as age, gender, and subscriber. This enables the benefit management solution to properly manage variations such as a 19 year old subscriber with an 18 year old spouse, which would be managed differently than an 18 year old subscriber with a 19 year old spouse. As a result, commercial payers can offer dental benefits and adjust their costs accordingly, all while minimizing the benefit administration burden.

Branded web portals


The first generation of provider and member web portals were like vehicles designed more for utility than curb appeal.

Today, provider and member web portals can be customized with logos, color schemes, and other brand standards to make them feel more personal - like just another page on the company website. The web portal can even include custom documents, whether explanations of the plans, announcements about wellness programs or other offerings.

More consumer-friendly


Health insurance in general has been slow to adopt the online technologies common in other industries. You can do a lot of cool things on a mortgage or vehicle website to determine your best options. But payer sites tend to be more static.

That is changing now as payers realize that consumer expectations for ease of use and intuitiveness are now being applied to their website and web portals. And that they expect the customer experience to be the same regardless of the device they’re using.

The bottom line is members will notice if their experience doesn’t match their expectations. Payers who recognize this and implement leading-edge benefit management solutions are gaining a distinct competitive advantage in a very tough marketplace.

Cyber benefits


This is the next frontier in benefit management – using automation more effectively, according to a published set of standards, to improve the entire benefit management process.

Take the issue of providers losing revenue due to patients not paying their portion in a timely manner. This promises to be a growing issue as deductibles, co-pays and other patient responsibilities rise.

If the provider is working with a cyber benefits-certified organization, he/she will be able to submit a pre-claim and have an explanation of benefits (EOB) returned almost instantly. The EOB will show exactly what the payer will reimburse and what the patient is responsible for so the money can be remitted while the patient is still in the office.

This capability will be a huge boon to member satisfaction as well. Rather than being shocked a month or more later that a procedure they thought was covered by their insurance will now cost them a huge amount out-of-pocket, they will know right away what their cost will be.

This is just one example. Moving to cyber benefits will enable even complex claims and requests for authorization to be processed faster. It will also reduce errors, minimize fraud, waste, and abuse, shrink benefit administration and delivery costs to the bare minimum, and ultimately improve member satisfaction.

At first, cyber benefits will be a competitive advantage for those who adopt it. Soon after, however, the choice will be to become a cyber benefits organization, or fade into memory.

Grab the advantage


While some question whether autonomous car technology will be an improvement over traditional driving, there is no doubt that enhanced benefit management technologies will yield a huge advantage to those that embrace them. You can either get out in front of the trend, or get left behind in the dust.

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Doug Wilkens

Doug Wilkens

As Director of Software Design, Doug Wilkens oversees a team of Product Owners, Business Analysts, and UX Designers that help turn requests for new system functionality from Wonderbox Technologies’ clients into reality. This process includes speaking with multiple Wonderbox Technologies clients and synthesizing their individual needs into configurable solutions. Doug and his team also bridge the gap between the business side and the development side to come to an overall best approach. They then set the priorities to ensure the team delivers the most valuable functionality as soon as possible.

Mr. Wilkens joined the SKYGEN USA family of companies in 2005 and has had a number of roles within the group of companies including data analysis, implementation, database administration and software design. He holds a Bachelors of Business Administration in Accounting from the University of Wisconsin-Milwaukee.

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