January 2022

2021 Was Quite a Year. Our Success Was Your Success.

1/14/2022 8:30:23 AM

2021 Was Quite a Year. Our Success Was Your Success.

by Craig Julien, Executive Vice President of TPA Operations

Most of us won’t soon forget 2021. For many, it was another year of hand washing, social distancing, masking, and staying home. Yet, even in the face of these seemingly unsurmountable challenges, our HealthSmart team pulled together to continue to provide innovative solutions and excellent service to our clients. Perhaps at no other time in our history has it been more important to deliver on our promise of treating our customers and our colleagues with dignity and respect .

Thinking about 2021, I began to make a mental list of all that we as a company have accomplished. It’s quite a list! First the high-level wins:
•    We achieved nearly 90 percent client renewals and 100 percent employee renewals;
•    We achieved a client satisfaction score of 98% which is a 4 percentage point improvement from last year, with a year over year improvement in all five categories surveyed.

We achieved a Net Promoter Score of 71!
One question we monitor closely is “I would recommend HealthSmart to another client or colleague.” The collective response to this question is referred to as the Net Promoter Score (NPS), a widely used metric that is considered the single most meaningful measure of client engagement. With a NPS of 71, we are in the top one percent of health plans in the country and where the average healthcare insurance company NPS score is 13, according to a national ratings agency. 

New clients brought new revenue
Thanks to the hard work of our network and sales teams, we continued to welcome new clients to all product and service categories. That meant we also grew revenues which enabled us to exceed our budget for the year. 

HealthSmartRx Solutions 
As our clients and their members faced escalating drug prices, our HealthSmartRx Solutions team provided proven interventions: 
•    Overall clinical savings of more than $20 million to PBM clients;
•    Custom clinical programs also saved $3 million for our clients;
•    Saved a new large, self-insured health plan client more than $1 million in specialty pharmacy costs in November alone;
•    Added new sales and operations teams to support the solutions including the development of a new web portal for some of our enterprise clients.

SmartDecision Reference Based Pricing
In 2021, SmartDecision Referenced Based Pricing (RBP) enhanced our ability to help self-funded health plans who are looking for an alternative to traditional PPO discounts by teaming up with HST, a recognized national leader in value driven health, to reimagine RBP: 
•    98 percent provider acceptance of Medicare-based reimbursement;
•    Expanded national PPO for physician and ancillary service improve member access and plan pricing;
•    Offered user-friendly technology featuring member and employer tools as well as resource utilization analytics for brokers and clients;
•    Our HealthSmart Concierge Advocates are able to access these tools to guide clients to high-quality, affordable care.

We are seeing a lot of interest in our new program enhancements and we’re excited for the savings this program will deliver for clients in 2022 and many years into the future. 

Care Management
•    Achieved full 3-year Utilization Review Accreditation Commission (URAC) accreditation with a perfect 100 percent score;
•    Signed a five-year contract with a large independent school district in south Texas to reopen an employee health clinic;
•    Expanded the workers’ comp transplant program, saving clients $22 million. 

Orlando SmartCare
Since introducing Orlando SmartCare to the central Florida market in the summer of 2021, area employers, self-funded health plan sponsors, and broker-partners have embraced this new insurance product. The integrated product offers Orlando area small to mid-sized self-insured health plans access to central Florida’s premiere network of hospitals, clinics, and providers at prices up to 20 to 25 percent lower than current market rates and up to 75 percent off billed charges. Based on the success of this launch, we are looking at other markets we can serve using this model.

SmartCasualtyClaims celebrated its 75th anniversary in 2021
Charleston, WV-based SmartCasualtyClaims (SCC), one of the nation’s oldest casualty claims administrators, celebrated 75 years of service to its loyal clients this year. The company achieved 99 percent client renewals in 2021 and 51 employees celebrated 15 or more years with the company. Several clients have been with SCC for more than 25 years! SCC is licensed nationwide, and handles claims for employers and insurance carriers in 20 states.

Again, thanks to our associates, clients and broker partners for their contributions  to HealthSmart’s phenomenal success in 2021 . The new year promises to be even more exciting and hopeful. We are optimistic that the start of a new year will lead HealthSmart to deliver results for our clients.

Craig Julien joined HealthSmart in 2016 as Senior Vice President of Operations for the Company’s eastern region. In 2018, he was promoted to Executive Vice President, TPA Operations, overseeing HealthSmart's core operational and service functions for medical, dental, vision, COBRA, FSA and STD claims administration.
Prior to joining HealthSmart, Craig served as Vice President of Global Operations for TriZetto, a Cognizant Company, where he was responsible for all aspects of claims operations, including receipt and entry of membership data, plan building, account management, inventory management, claims processing and customer service. He has 20 years’ experience in BPO operations, 10 years’ experience in the healthcare payer vertical and eight years' experience with the QNXT and QicLink platforms. Prior to his experience at TriZetto, Craig held senior level roles with Kenexa Technologies (an IBM Company), Ceridian, and CNA Insurance Companies.

Craig holds an MBA from University of California – Irvine, a BS in Business Administration from University of Phoenix, and a number of certifications, including a Six Sigma Green Belt.