Simplifying the Benefit Plan Management Process
Simplify Healthcare
03/05/2018
Simplify Healthcare is now a part of the Alliance GPO. Download their GPO contract for details on available discounts, savings and value-added opportunities. Visit their vendor directory listing to learn more and see a list of their current Alliance customers.
The story of Simplify Healthcare
It’s been said that necessity is the mother of invention. And when you live with a complex, error-prone, manual benefit plan configuration process day-in and day-out for years, innovation can strike.
That’s what inspired Mohammed Vaid to found Simplify Healthcare (formerly The Most Group) a decade ago. As someone who had worked at health plans for years and who had suffered the inefficiencies of creating benefit plan proposals first-hand, Vaid knew there had to be a better way.
The Vision
Vaid saw opportunities to simplify key administrative processes in health plans due to the lack of single sources of truth for various critical operational information. By establishing single sources of truth and simplifying related processes, health plans save costs, have additional resources to invest in other areas and can better enable revenue growth. Simplify Healthcare represents Vaid’s intent and commitment to simplify business processes surrounding inherently complex systems deployed at Health Plans.
Given the industry demand for customized plans, Vaid knew his solution had to be highly configurable and easy to use, without having to rely on IT. His vision was to replace band-aid solutions and disconnected manual processes with a streamlined end-to-end solution for health plans struggling with manual processes, errors, compliance, and penalties.
Working with a team of software developers, Vaid designed the first modular software solution specifically for health plans and third-party administrators (TPAs) to streamline the benefit plan management process to reduce errors, ensure compliance, minimize risk, cut costs, save time, and improve plan sales — making the quote to card process highly efficient and pain-free.
Not only did Vaid see a gap in solutions, he was a first-hand witness to health plans spending 10s of millions of dollars and years of investments trying to solve these problems and unfortunately failing. Vaid knew that a well-designed solution could be delivered in weeks or a few short months rather than years, enabling health plans to realize their business cases almost immediately.
Vaid’s vision has been delivered in full for the health plans using Simplify Healthcare’s solutions.
Industry Recognition
Since its inception in 2008, Simplify Healthcare has been recognized by a number of organizations with numerous awards and endorsements. It was named Best Newcomer at the Healthcare IT Summit Excellence Awards in 2014. It won a Corp Magazine DiScitech Award in 2016. And eBenefitSync, Simplify Healthcare’s flagship product, was named a sole leader by IDC in the US Health Plan Product/Plan Benefit Solutions 2016 Vendor Assessment. AP2, the company’s value-based reimbursement solution, scored the highest compliance rating in IDC’s Technology Spotlight review in 2017.
Leadership
In addition to Vaid, Simplify Healthcare’s leadership team provides deep expertise in benefit plan management, Medicare product compliance, provider data, and contract management and value-based reimbursement, particularly in the payer space. Looking ahead, the company’s goal is to continue to deliver innovative technology solutions aimed at simplifying complex health plan problems with elegant, yet practical solutions.
Products
Simplify Healthcare offers a variety of robust, award-winning solutions:
eBenefitSync
This market leading benefit plan management solution provides straight through processing for standard plans and ease-of-use for customized plans by creating a single source of truth for benefits data that can auto-generate plan documents. eBenefitSync’s workflow and rules engine deliver benefit information from eBenefitSync’s information repository directly into the systems that need it, precisely when they need it, with no human intervention required.
eBenefitSync is a highly configurable, modular, and scalable product that increases operational efficiencies, reduces administrative costs, and increases speed-to-market. Its modular approach allows users to implement any or all modules to address critical pain points, or deliver an end-to-end product lifecycle for benefit plans. The solution helps health plans simplify benefit plan configuration with intelligent decision support for sales, product development, and document generation teams. It also enables all stakeholders to collaborate with integrated case-specific workflows.
With a patent-pending process algorithm, eBenefitSync guarantees improved speed-to-market, accuracy, and cost effectiveness of benefit plan design, configuration, and reporting processes. Unlike other cross-industry BPM and product lifecycle management solutions, eBenefitSync is the only SaaS-based benefit plan management solution that addresses the end-to-end benefit product lifecycle for health plans and TPAs.
eMedicareSync
The industry's first CMS PBP integrated, turnkey Medicare Advantage product/plan configuration and document generation (ANOC/EOC, SB) solution, eMedicareSync helps Medicare plans automate the CMS PBP Bid process, improve accuracy, timeliness, and reduce efforts and costs by up to 75 percent.
Today, many health plans rely on spreadsheets for their Medicare/Medicare Advantage product configuration, which creates errors, requires duplicate data entry, and takes multiple rounds of manual validation. Instead of eleventh-hour document updates turning into fire drills, eMedicareSync automates the end-to-end Medicare Advantage product lifecycle and ensures compliance by collaborating with all stakeholders to eliminate errors, inefficiency, and risk.
In a nutshell, eMedicareSync offers auto-compare of products to ensure effective and efficient audit/QA while improving speed-to-market, streamlining last minutes changes, generating CMS PBP output and documents, enabling workflow collaboration across all stakeholders, and providing annual compliance updates for CMS’ PBP software and ANOC/EOC Model documents. Best of all, health plans can throw away the product configuration spreadsheets.
eProviderSync
eProviderSync is a SaaS-based provider and provider contract management solution that automates the end-to-end provider life cycle and enables providers to create a single source of truth. It helps providers configure contracts with intelligent decision support for provider data, directory, network and relations teams and generate provider notifications, credentialing, authorizations, and contracts from a single data source.
The solution lets users house all types of provider models to include innovative affiliations demanded by value-based purchasing and contracting. eProviderSync’s ability to increase data accuracy ensures consistency of provider data and contracts across health plans, which further elevates net promoter and customer satisfaction scores. It also improves the speed, accuracy, compliance, and cost-effectiveness of provider data and contracts.
Additionally, provider data from the single source of truth repository can be routed to claims and other systems to maximize the accuracy and effectiveness of processes across the health plan.
Advanced Payment Platform (AP2)
This value-based reimbursement solution combines existing analytics capability with a powerful reimbursement engine that complements existing claims-based payments. AP2 lets users house all non-bundled Fee-For-Value (FFV) payment programs in a single solution while robust audit and automated retroactive algorithms ensure compliance and transparency for health plans and providers.
AP2 helps automate value-based reimbursements and generate transparent FFV payments with the highest compliance rating in IDC’s review. It also improves FFV payment accuracy and timeliness enabling Health Plans to administer pay-for-performance, shared risk, partial cap, and full cap payment programs for various services and chronic conditions. With AP2, a health plan can incorporate incentive payments based on provider performance, PCMH care coordination fees, and administrative fees. Additionally, the plan can even create innovative chronic condition-based payment programs. And of course, health plans can throw away the FFV Excel spreadsheets.
With a suite of solutions that streamline error-prone manual processes to generate real bottom line results, Simplify Healthcare continues to innovate and break new ground. To find out more visit simplifyhealthcare.com, email mark.manning@simplifyhealthcare.com or call 508-450-8866.