From Competitor to Colleague: How Is ClaimDOC Different?
One of the hardest things for brokers and clients to judge is how their experience with ClaimDOC stacks up against other reference-based pricing programs. Without relative experience to draw on, it’s tough to know what “good” even looks like. Experts online and newcomers offline tend to lump all RBP programs together. So how can we expect plan sponsors to appreciate the differences?
I’ve worked with RBP plans for 12 years — first as a third-party administrator representative, where I became a believer after working on numerous programs. When that TPA was bought by private equity and merged with an RBP vendor, I got to see the full picture behind the curtain. I thought it was a good solution but, like many of you, I wondered how it compared. Now that I’m at ClaimDOC, I have that perspective — shaped not only by working for both organizations, but by being on their RBP health plans. Ironically, my prior employer marketed itself as the only RBP vendor that uses RBP for its own employees. They were either lying, or they were too lazy to research if their claim was true.
This is just one example where I’ve learned that not everything is at it appears. From TPA arrangements and promised customer service to more nuanced details — I can now distinguish between the sameness brokers and employers see on paper with RBP pitches.
TPA Arrangements
One of the biggest differences shows up in the TPA relationship. ClaimDOC works with a diverse set of TPAs — some better than others. If your program runs through a weaker TPA, you can get a better experience elsewhere. RBP services suffer when the TPA isn’t operationally sharp and fully sold on the model.
My prior firm rolled two TPAs and an RBP vendor under common ownership. At the time, I never appreciated the value of not letting the fox watch the henhouse. Managing every aspect of plan funds, including applying contract rates, multi-level payment matching and fee structures, is hard. When you have two unaffiliated organizations watching the activity, plan sponsors get real guardrails without having to track every dollar themselves. Bundled carriers are getting torched by the transparency movement. My old firm’s model — affiliated entities waiving fees here and collecting them there inside a mind-numbing contract — is exactly what that movement is reacting to. I’m thankful ClaimDOC has no affiliated TPA ownership. One of my colleagues said it best: “We partner with quality TPAs AND hold them accountable.”
Proactive Member Engagement
ClaimDOC intimidated me when I sold against them. Brokers raved about their provider outreach, but I didn’t get it. Don’t all vendors do proactive outreach? Having now seen it firsthand, it’s more impactful than I thought possible. Change management is everything when moving away from networks, and the one-on-one member support that the Pave the Way® program delivers is powerful. Members aren’t ready to have choice stripped away, and this service fills the gap. It drives substantially more savings by avoiding contracts, but the psychological value of the personal relationship between members and their advocate is just as real. This program is the main reason I joined ClaimDOC.
So how does it compare? Every vendor claims to help members with access and touts great service. I often see competitors copy ClaimDOC’s selling points, such as a human touch and a direct support line for members. What’s always missing isn’t just that they don’t have Pave the Way, it’s that they don’t have any program that creates engagement with their service team. Their idea of proactive outreach is like selling clients an extended warranty they hope never gets used. They are not willing to take that capacity gamble, so they don’t promote a program that results in higher volume of work that would align with their sales pitch. The difference is ClaimDOC wants the calls to come in. We believe engagement makes a positive impact on the success of the plan, and we welcome the volume. We are committed to success, not cliches and copycat marketing.
The fact that no other vendor does this tells you just how special it is. Over the years, my previous employer drifted from a customer-service focus to an ROI focus. The CEO’s own LinkedIn work history touts growing profitability and positioning a business for exit. That’s why no one builds the proactive relationship with members. Why do the hard work when it’s more profitable to use marketing efforts to get inexperienced buyers of RBP to fall for your member experience sales pitch?
The People Are Different
ClaimDOC’s member advocates aren’t tucked in a corner, based in another state or working remotely. More than 100 member-facing employees sit centrally in the West Des Moines home office. They are the hub of activity, collaborating in person with staff across the company to solve issues. Member advocates are celebrated as critical to the mission and operate in full view. I used to find ClaimDOC’s public love affair with its advocates a little absurd. But it didn’t take long after being here to get it. It’s just who the company is.
As I mentioned, my wife and I are on the plan and experiencing a level of service that I thought was just a sales pitch. We’re on a first-name basis with our ClaimDOC member advocate, who’s been exceptional at securing access for my wife’s physician visits. At my old firm, we weren’t even invited to nominate providers. When we had needs, it felt like a typical call center.
The Factory Experience
These program elements rarely show up in a presentation full of nuanced details. What pulls them to the forefront at ClaimDOC is daily, account manager-led collaboration across the member advocate, provider relations, legal and auditing teams. At ClaimDOC, that collaboration is personal and on-site. At my old firm, it was electronic, impersonal and scattered across offices and states. Once again, it’s more profitable to put the clients on a conveyor belt and give them the standard factory experience. Factories are more efficient, but the problem is clients are paying much more for that off-the-shelf support model than they would with ClaimDOC’s more dialed-in program. Paying more for less isn’t a typical procurement strategy for companies.
When I met with benefits advisors after joining, they wanted to hear, straight from someone who’d been on both sides, why ClaimDOC is superior. This article is part of my answer (as well as my wife’s perspective). I hope it’s useful the next time you wonder what other RBP vendors are like.