Efficient Forums

Don’t Get Me Started!

It seems that the politicians are bantering about the tragic health care problem again. Has it really been four years already? I have to say this is one issue that really gets me going, and I have to admit I am not an expert in all the legal, political, social, and regulatory issues relating to health care and making sure people get at least minimal health care insurance. In the last month, I bet I have had at least five to 10 long conversations revolving around the health care issue. I usually start by saying, “Don’t get me started,” then within five minute I am started again. (I make a quick apology, but I warned them.)

It goes like this … Health insurance sucks. Small businesses pay crazy inflated prices and can never get a reasonable break for providing health care to their employees. Twenty percent or more annual increases are bad enough, but that is just the beginning because there is no end to the cycle. Small companies are forced to offer coverage to all employees, if they offer it at all.

I agree providing health insurance is the right thing to do. I guess it is appropriate that I can’t ask if an employee is sick, has any “pre-existing” condition, or is ever going to get pregnant. It even makes sense that I can’t ask if their family is sick.

The Pain

What gets me, though, is this … Because the increases continue year after year, the healthy persons’ costs and the healthy families’ costs increases to the point where the obvious happens: healthy families leave the plan to save hundreds of dollars per month and receive better coverage outside of the employers plan. Yes, the singles stay in but only because the employer pays for them. At some point, it becomes too expensive for the employer, who is then forced to drop coverage and, in turn, send all people to the individual health market. This means that the sick families are completely sunk, and most young people would rather buy beer then health insurance so they go uncovered. And so the problem mounts…

What also kills me is that when I try to join a PEO (Professional Employers Organization) to gain some economies of scale and, potentially offer my employees better options and plans, the first thing they require is that I make everyone complete a health survey. The PEO can reject us if we have “pre-existing” conditions. This is more than a bit frustrating.

Also if you haven’t noticed, your health insurance broker recommends you switch coverage every two years so they can get a higher commission. But notice when you’re shopping rates, your broker comes in and says, ‘You know, if you get your employees to complete a health survey, we might be able to get you a break on your coverage.’ Why is it that only the small businesses owner can’t ask the questions that everyone else is going to ask after you have an employee? In my opinion, the system is flawed.

Let’s Fix It(?)

Of course, nobody really knows how to fix it. And, I will be straight up with you, I probably can’t fix it either … But if I could, here is how I would fix it, and it doesn’t need to take that long.

First, I would talk to all the major insurance carriers (none of which want a federally mandated UNIVERSAL HEALTH coverage because we’re not socialists…). The goal of these discussions is to determine whether they would be interested in joining our platform whereby their plans and offerings would be available to a massive number of employers, and we’d include guaranteed distribution, greatly lower administrative onboarding costs and lower commission costs.

The large volumes of employees coming to the platform from employers and individually would allow for more efficiencies, lower costs, and better services to the covered customers. The carriers would be asked to pool resources to underwrite and provide a collective plan, available and affordable to the masses and potentially subsidized by the federal government in certain circumstances. (Note to reader: As a teaser, I am currently speaking to several carriers at this time about some of this, and they don’t think I am completely nuts).

After I position the platform to the carriers and sufficiently get their attention, I approach Barack Obama and John McCain (Hilary Clinton is done, but hey, I’d talk with her too). Once every four or eight years, small company CEOs get a rare chance like this. We get to actually talk substantively with the guy who may rule the world someday just because votes really do count!

I would ask the politicians, ‘Do you really understand the nature of the health care insurance problem and if so, do you really want to try to fix it?’ The answer is probably not a strict universal health plan but a combination of private insurance carriers and some sort of coverage that is federally mandated for a stop gap. The plan must make sure the burden of health care for the sick doesn’t keep falling on small business.

Next, we need to line up national distribution to bring the masses onto the platform, which is a cake walk compared to the first two steps. One key driving benefit employers will get is better packages for their employees to choose from at lower costs. Other side benefits for employers to join the platform include lower employee onboarding costs at hire and lower administrative costs with relation to enrollment paperwork and tedious handling of enrollment and other employment paperwork including I-9, W-4, etc.

While I won’t dive into how the distribution can be won quickly (I have to leave some of this for later posts), I will lead on that this step may be the most disruptive to the status quo. The Efficient Health Care platform, of course, is powered by Efficient Forms Transaction Origination Platform (TOP) which allows for many efficiencies, including employer self service. And since employers still somewhat like talking to people when they buy insurance, a unique national distribution plan will change the way and the place we buy not only health insurance but other insurance as well.

I know I haven’t gone into enough detail yet to appease the skeptics, but since I can’t fix this problem anyway, what’s the use?

A while back I read a research paper by Gartner, Inc. that discussed the importance of Content Enabled Vertical Applications, or CEVAs. While the drive for automation, efficiency, cost reductions and facilitation of revenue generation is what every corporation is looking for from technology companies, it amazes me that most have taken the easy road and automated everything after the fact; either after the transaction is complete or significantly after the event occurred. I will explain further in a bit.

The Problems

There are a number of general problems out there that we live with or deal with from time-to-time like applying for insurance, applying to graduate school or helping a student apply to college, completing paperwork when buying or selling a house, completing paperwork when submitting claims, filling out forms at doctors’ offices, filling out forms at county offices … do I need to go on?

We all simply complete the required paperwork, but I know a lot of you think, “Why the hell isn’t this automated? The doctor asked me the same questions last time I was here.”

You live with it because it isn’t that bad, and you really don’t go to the doctor everyday or help your child apply to college everyday … or apply for new insurance everyday.

But, there is a major problem. You fill out forms by hand using a pen while someone else keys it into a back-end system of some sort (hint: the ENTERPRISE CONTENT MANAGEMENT SYSTEM). Your handwritten form is inherently fraught with errors (while you won’t admit it, your handwriting does stink, and it is getting worse every day because you use e-mail to communicate instead of writing a nice letter to your mother, which is another subject … memo to self: write more to your mother).

Where was I? Ahhh yes … fraught with errors that are very costly to fix and potentially cause very bad and unintended (we’ll call them) situations. Typically, you spend unnecessary time with a receptionist who has to take the brunt of the situation. Or even worse, the error causes someone to prescribe a potentially dangerous medicine, and you get sick or worse.

Nonetheless, the people on the receiving end of the redundant, ill-conceived forms are inundated with issues that are time consuming, costly and error prone. So why does this problem still exist? (I know I ask myself this every time I complete a form.) Well, here is the answer: Software and data vendors have focused only on the problem of what to do with the form once it is received for processing.

What of ECMS?

ECMS are all over imaging, storing, indexing, distributing, and managing a completed document. These solutions have come a long way, but I would suggest they have yet another leap that must be made to solve the problems I have been discussing … if I have to fill out one more form for health insurance…!

Back to that research paper by Gartner entitled, “Magic Quadrant for Enterprise Content Management, 2007“: Gartner discusses that the top ECM vendors, namely IBM, Oracle, EMC, Open Text and others, offer very similar components in their suite of services. Gartner stresses that while EMC vendors’ customers have been screaming for industry-specific solution on the front end of CEVAs, the vendors have not offered solutions other than customized, expensive, single-problem, non-repeatable solution provided by overpriced professional service/consulting partners (where billable hours are still king).

We know these partners as the “companies nobody ever got fired for hiring” … EDS, Accenture, etc. Gartner states that all major ECM vendors must focus on CEVA solutions to maintain a competitive advantage in the ECM space.

Hmmmmm … Easy to deploy and maintain. Repeatable CEVAs for any industry. Interacts with customers, sales reps, outside agents, wholesalers, managers, and back-end ECM systems. Facilitates the entire transaction origination - potentially paperless - through the company, back and forth to the customer, keeping everyone informed of the status every step of the way. Hmmmmm … It’ll never happen!

WRONG, it can happen. Right now. It’s available!

The Efficient Forms Transaction Origination Platform (TOP) was created for this purpose and is designed to allow business analysts with domain knowledge (note: non programmers), to configure, deploy and maintain complex CEVAs.

The horizontal solution is changing the way data is captured, forms are completed and data is transmitted to ECM solutions. TOP-created CEVAs are not meant to replace any components of existing ECM vendors’ suites. TOP solutions will dramatically extend the functionality of these ECM solutions, and ECM customers will rejoice!

And one day you will tell your children that they have it easy. “When I was growing up, we had to actually fill out five or more forms every time we went to the doctor … with a pen no less … on every separate form, I had to re-write my name, address, social security number … you don’t know how lucky you are!”