Case Study 2.7.2014

Innovating To Create Market Disruption In Ways That Legacy Insurers Cannot

Trexin developed disruptive business and technology strategies that will bring more positive health outcomes for consumers.

Business Driver

The advent of the Affordable Care Act created a new type of private nonprofit health insurer, called a Consumer Operated and Oriented Plan, or “CO-OP.” These plans are directed by their customers and designed to offer individuals and small businesses more affordable, consumer-friendly, and high quality health insurance options. The ACA mandate will foster the creation of qualified, nonprofit health insurance issuers to offer competitive health plans in the individual and small group exchange marketplaces. One of Trexin’s clients had been selected by the federal government to operate as a CO-OP and provide affordable health plans to many who are currently uninsured and underserved by existing insurers. The CO-OP engaged with Trexin Consulting to advise on the start-up of its health insurance company and to navigate the following issues:
  • Development from funding to fully operational, with networks, campaigns, systems, and, support in a six month timeframe.
  • Create a new type of insurance and health care experience for the potential consumer, the member, and the provider.
  • Establish and sustain people, processes, and technology to grow and support the new organization.
  • Navigate and thrive in the new world of the Affordable Care Act and promote simplicity and innovation among consumers, members, and providers.
  • Operate on a lean budget in order to compete with existing and entrenched carriers, while innovating in the marketplace.
  • Hire highly competent, creative, and experienced staff with an understanding and passion for the CO-OP vision and mission.

Approach

Trexin’s strategy on developing the health insurance client focused on a Business Process Outsourced (BPO) approach to enable health plan creation. In this approach, Trexin helped the client to contract with highly experienced partners to create the needed technology and business processes to successfully enroll and support all corporate and health plan functions. Trexin prioritized business and technology needs and solutions using detailed road-maps. Additionally, Trexin instituted guiding principles for vendor management including: Leveraging best of breed technologies and approaches; Reusing existing capabilities where available; Buy/outsource needed capabilities from proven vendors; If needed capabilities are unavailable, build as last resort. Finally, Trexin assisted the health insurer CO-OP in exercising disciplined project methodology with thorough strategic road-mapping, requirements documentation, solution testing, and agile iterations.

Results

Uniquely flexible to respond to CMS requests & Affordable Care Act regulations, market shifts & industry disruption, and the competition’s strategy & tactics. Ability to build tight, innovative, and mutually beneficial relationships with members through simplicity and education and with providers through favorable fee schedules and performance incentives. Greater control over business and technology costs and maintenance though business process outsourcing model, zero legacy systems, and cloud-based/pay-as-you-go technology solutions. Educational and thought-provoking outreach and messaging to communicate that the CO-OP is different from other carriers due to non-profit values, health care literacy efforts, simplicity of doing business, thorough provider networks, and consumer-friendly tools and systems.

Tagged in: Aligned Enterprise, Healthcare
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