“I need it to integrate.”
These five words are said by every health care broker and HR manager when discussing HR software. Whether a system integrates and how it integrates is discussed on every single discovery call with every HR software vendor. Because the answer is complicated, the ensuing conversation often leaves no one satisfied. It’s frustrating!
Let’s take a step back and discuss what it means for software to integrate. When it comes to benefits administration software integration, we’re largely talking about communicating eligibility and election information from the benefits system to the carrier system.
From the broker’s perspective, this should be seamless, like the way Apple products work.
“I took a photo on my iPhone, and it popped up right on my Apple TV! My daughter messaged me about it, which came on both my Macbook Air and my iPhone at the same time. Boom — integration.”
Is this how benefits administration software works? Not exactly. Apple has set the bar so incredibly high, which is why it is the most valuable company in the world, but it isn’t reflective of how integration works for benefits eligibility communication.
At a basic level, two databases have to talk to each other to create integration. In benefits administration, this is particularly tricky, as the average insurance carrier often has multiple databases — one for eligibility and one for billing, for example.
This is entirely different from how Apple works. Apple has a single database from which all your Apple devices pull. In other words, the experience that Apple delivers is not an integration at all. It’s just multiple presentation layers, or what the user sees, all pulling from the same database.
With benefits, there is integration because the benefits software has a database that is different than the insurance company’s database or databases. Furthermore, these different databases are also generally configured differently. This means you can’t just “turn on” an integration and have data appear accurately in both systems. On top of that, the insurance industry isn’t as technologically advanced as other industries, so integration limitations are often based on insurance company limitations.
You may be thinking — will there ever be a “single database” solution like what Apple has created, but for HR and benefits in the small employer space? Let’s look at two possibilities.
1. Carrier-centric approach: Carrier adds HR functionality to its platform
With this approach, every carrier would have to build out HR functionality and offer all products. For example, Blue Cross Blue Shield would have to make functionality such as PTO tracking available as part of its software platform. This is very unlikely. It would take a significant investment in development, and it would also require that employers feel comfortable turning all of their HR information over to their insurance company. We are not aware of any carrier even trying to do this.
2. Employer-centric approach: Carriers rely more on HR platform databases
The more likely solution is the employer-centric approach. This would mean that carriers would rely more on HR platforms to hold the most up-to-date and accurate information when it comes to benefit elections. Worried that the employer-centric approach wouldn’t be perfect? It won’t be.
There are still going to be situations in which there just simply can’t be a single database. For example, at the point of service a doctor’s office is still going to have to call the carrier to verify coverage. For this reason, in most instances the carrier will still need an eligibility database.
Payroll is another example of where multiple databases may have to exist. However, payroll providers are already working to address the problem of multiple databases by developing open API. For example, ADP has created its own App Store similar to Apple’s called the ADP Marketplace. ADP requires software companies to integrate via an API and meet specified requirements that ensure high quality and real-time synchronization of data.
While the HR and benefits industry does not have anything approaching Apple’s answer to the “integration problem” yet, it is headed in the right direction. When you are evaluating the different systems out there, ask them where they are in the journey of integrating with the insurance companies and payroll providers.
Do they have any API integrations? Are they with payroll and insurance companies, or just one or the other? How do they charge for the integrations? Do they have any of their own API to make it easy for other parties to integrate with them? Do they have an iPhone and Android app, indicating the ability to make more APIs available in the near future? Are they doing billing for any carriers, thus moving towards an Apple-like solution to this integration problem for brokers and employers alike? The answers to these questions should direct you toward a product leader.
This column is adapted from the book “Online Benefits Technology: The Strategic Broker’s Guide.”