Industry inefficiencies related to Coordination of Benefits (COB), a situation that arises when an individual is covered by more than one insurance plan, was estimated to be $840 million (split roughly 60/40 between providers and health plans). A national consortium of health plans wanted to address systemic inefficiencies in how benefits are coordinated when an individual has multiple forms of coverage. crankfrog was hired to develop the overarching product strategy that would address these inefficiencies. Specifically, crankfrog’s role was to program manage the design, development, implementation and roll-out of an industry-wide, multi-stakeholder solution.
Our Solution Approach
As overall program manager, crankfrog facilitated a strategic planning process for the consortium Board of Directors to assess the market opportunity, mediate competing priorities, and develop a solution concept. With approval on the solution concept, we provided recommendations regarding RFPs responses, including detailed cost and pricing analysis of various vendor organizations. We also played a pivotal role in writing product requirements in conjunction with a partner vendor organization, including data requirements aligned with individual state coordination of benefit rules and design of member coverage information required to identify existence of COB.
To validate the product met stakeholder needs, we facilitated meetings with health plan workgroups to define test scenarios and cases which verified the product returned accurate primacy decisions; and held discussions with participating health plans to confirm requirements, approve decision rules, and establish a plan for implementation. Finally, crankfrog managed participating health plan contract development and execution.
Results & Benefits
crankfrog successfully managed product implementation by twelve health plans representing 130 million member lives, which led to the identification of 6-million-member coverage overlaps. Identification of coverage overlaps enable participating health plans to:
- Reduce the number of pended claims and increase claims automation rates;
- Reduce COB claims processing staff;
- Improve process cycle times;
- Increase secondary COB identifications and recoveries;
- Increase cost avoidance savings and overpayment recoveries.
The solution is the most complete national repository of COB information, has become the organization’s second most successful product in their portfolio (by gross revenue) and has led to a 40% increase in member health plans’ ability to detect coordination of benefits opportunities.