Think of Pro-Claim Plus and PHP as peanut butter and jelly; each ingredient brings a distinct flavor to the table and, when combined, complement each other for a satisfying outcome.
“Some things just go well together and we feel like Pro-Claim and PHP are a good fit,” says Karla Linvill, president and CEO of Pro-Claim Plus, Inc. in Fort Wayne. “Pro-Claim is a third party administrator, meaning we provide administrative services for self-funded health plans.”
Linvill explains there are primarily two options for employers to choose from when it comes to providing health insurance for their employees: full risk and self-funded.
“PHP handles full risk products and we handle the self-funded side of the house,” says Linvill. “With full risk, employers pay a set premium to the insurance company each month and it’s pretty much a package deal. With self-funded products, employers customize their plan and it’s very much ‘a la carte.’ The employer takes on a portion of the liability in a self-funded plan – with protection through reinsurance contracts – and gains flexibility to make more decisions and design its own, unique plan. Many times, a self-funded plan is less expensive for the employer in the long run.”
Linvill says self-funded works well for many companies, yet it’s best to study analytics before making a decision to change.
“With data available through a self-funded plan, employers are better able to analyze the needs of their specific workforce. For example, a construction firm may decide to cover more physical therapy and chiropractic visits. We can design the plan so that it helps to keep costs down for the employer while also meeting the health and wellness needs of the employees.”
PHP officially acquired Pro-Claim on Sept. 29, 2017, after Pro-Claim Plus and PHP recognized a potential partnership would be beneficial to both companies by capitalizing and supporting each other’s strengths.
“The more we talked, the more we realized there were many commonalities between the two,” says Linvill. “We found we were on the same page when it came to our thinking and what we felt was important; how we were portrayed or how the outside viewed us; how we viewed our employees as well as our ethical standards. Both PHP and Pro-Claim are good, solid companies with strong reputations.”
Linvill points out that self-funding is a growing segment of the industry. The staff are noticing an increased shift toward self-funded health plans.
“Many smaller companies are starting to consider self-funding because they’re becoming better stewards of their budgets and are studying every little component of their health plans,” says Ava Lillmars, senior account executive with Pro-Claim. “With full risk insurance, you can’t really ‘see behind the curtain’ so to speak. Self-funded opens the curtain because of all the detailed, aggregate analytics we can collect and share with the employer. You can’t do that with full risk.”
“Another thing we can do is plan modeling,” says Mary Clancy, chief operating officer of Pro-Claim. “An insured group might ask, ‘If I increase my deductible by $500, or put a limit on a certain benefit, or change a benefit, what would my savings be?’ We take the information that we’ve already processed on that group, make the requested adjustments and let the group know how much they, as the client, would have paid out and what that would have changed in their plan design. It’s a nice exercise for a client when they’re renewing, if they want to consider a revision to their plan.”
Pro-Claim chief information officer Jim Hartzell says the fact that Pro-Claim Plus has a proprietary software system is another differentiator.
“It’s our own system that we designed and continually enhance,” he says. “It allows a great deal of flexibility and speed so that we can make changes quickly. We don’t have to go to an outside vendor for requests to add a new feature and wait for months for completion of the request. We can do it ourselves right away.”
As Pro-Claim and PHP enter their second year of business together, they are in the process of moving under one roof. Linvill is optimistic about shared success and continued opportunity.
“I believe success is in the eye of the beholder. It’s not just about the numbers. To me, success is doing the best job we can for our clients, building relationships, and giving them service that doesn’t just meet – but rather exceeds – their expectations.”
This article was originally written and formatted for BusinessPeople Magazine and published on October 8, 2018. The article written by Jennifer Blomquist with photography by Jeffrey Crane.
