Can one app manage pricing, communications, and payments for health plans?

In short, YES!  Medxoom "unifies member identity, pricing, communication and payments into one, easy-to-use app".

For Episode 82, my guest is James the EVP of Strategy and Growth for MedXoom.

His hobbies are triathlons, for which he trains 16-20 hours a week to prepare for events, and scuba diving.  Jame calls himself "a back-of-the-pack triathlete", and recently he had to back out of a full Ironman race in Florida about 36 hours prior to it starting because of a lung infection.

James has also performed well over 500+ deep dives, saying it is the most peaceful and exhilarating experience simultaneously.  He even once found a 1-carat diamond ring during his adventures, as well as visited many underwater shipwrecks.

James started his career out in the legal world, then moved on to sales with ADP, then PEO sales, before finding himself in SaaS tech centering around human resources with Namely.

His current company is MedXoom, which is a technology platform that has the ability to improve the financial outcomes for both plans and members.

Medxoom creates a true white-labeled member experience, with clients ranging from Third Party Administrators, Health Plans, Brokers, and many other solution providers selling out to employers directly.

Health Plans have nearly an infinite number of combinations of solutions folded together including things like Telehealth, Direct Primary Care, carved-out PBM’s, Reference Based Pricing, etc, and Medxoom allows the administrator to bring all of those components together, white-label in one singular experience, so the member has one place to go.

Members can do things like:

- Use their Benefits Wallet

- Search for Care

- Engage with a Care Navigator

- Align with a Provider on Price

James said one of the reasons they get such good member engagement is that many of their employer clients have gone fully digital, even eliminating plastic ID cards.  “You go fully digital and you get adoption”

With plans who have done this, they see 70% + in downloads and enrollment within the first week of launch.

They also partner with 3rd-party data providers in order to large ingest machine-readable files with pricing data so members can easily search for cost details of care, which helps employers be compliant with the CAA.

In the near future, the app will even be able to recognize if certain procedures are searched for and turn that information over to a case manager to proactively help determine the best course of action.

Medxoom is also assisting with improving the provider payment process, using something called a “Single Payment Credential” or SPC card.  This functions as a single-use, virtual credit card loaded with plan dollars allowing for a closed-loop transaction that pays the provider in full.  Medxoom takes it a step beyond and can even float the money for their clients to ensure a frictionless transaction.  All of this has led to 100% acceptance of payments using this method.

Best of all, Medxoom’s clients are giving them data that shows on average, using the SPC method of payment, they are realizing a 40% reduction in unit cost versus traditional network arrangements!

Chapters:

0:00 Triathlons & Skydiving

11:58 James' Career Path

20:30 Intro to Medxoom

31:20 Medxoom Partners

38:53 Solving the Payment Problem

46:07 Who is it for?

55:00 Future of Healthcare

56:50 Closing Thoughts