Life as a Serial Entrepreneur - Mark Combs - Self-Insured Reporting - Episode 45

This episode features an interview with Mark Combs, a serial entrepreneur and founder of SelfInsuredReporting.com and ACAReportingService.com, focusing on his journey, marketing philosophy, and the technological modernization of the self-funded employee benefits space. Combs details his transition from a successful employee benefits broker to a full-time entrepreneur, highlighting the initial struggles and failures he experienced before finding success by addressing critical operational gaps in the insurance industry. The conversation emphasizes the power of authentic, unique marketing (exemplified by his viral video featuring a taxidermied marlin) to break through the "vanilla" content prevalent in the professional services sector.

The core of the discussion centers on SelfInsuredReporting.com, a platform designed to automate and standardize the complex financial reporting process for self-funded employers, a task traditionally performed manually using error-prone Excel spreadsheets. Combs explains that the platform integrates data from over 120 different Third-Party Administrators (TPAs) and Pharmacy Benefit Managers (PBMs) to create accurate financial reports, track monthly claims against budget, project year-end costs, and manage stop-loss reimbursements. This automation frees up brokers and internal staff from weeks of manual data compilation, allowing them to focus on strategic analysis and client consultation. The platform’s ability to integrate fixed costs and stop-loss contract specifics is highlighted as a key differentiator, providing a comprehensive financial picture that is often missing in standard claims analytics tools.

Combs also introduces PlanWell Health, a new app-based solution fully integrated with their reporting platform, aimed at driving member engagement and closing gaps in care—a concept inspired by the highly successful Asheville Project. This app allows clients to design customizable wellness and disease management programs, incentivizing members (through points tied to lower employee contributions) to engage with clinical messages, health risk assessments, and physicals. The goal is to make healthcare actionable at the member level, recognizing that closing gaps in care significantly reduces risk and costs. Finally, the discussion touches on the future of the healthcare ecosystem, noting the disruptive potential of data transparency, the threat posed by big tech (like Swiss Re/Google’s Coefficient/Granular), and the potential necessity of legislative intervention if the industry remains too fragmented and resistant to standardization and collaboration.

Detailed Key Takeaways

• Automation is Essential for Broker Bandwidth: The manual process of creating financial reports for self-funded clients (often taking two weeks per month) consumes immense broker bandwidth. Technology solutions that automate the integration of claims data, fixed costs, and stop-loss contracts are crucial for freeing up intelligent personnel to perform strategic analysis rather than data transcription.
• Data Standardization is a Competitive Edge: Stop-loss carriers that actively pull in and utilize comprehensive claims data (including trigger diagnoses and PBM data) will outperform those relying on less robust, traditional data sets. The move toward standardized, detailed data is a major threat and opportunity, as demonstrated by initiatives like Coefficient/Granular.
• The Importance of Financial Reporting Accuracy: The platform solves critical issues related to data discrepancies, such as retroactive changes in TPA reports, late filing of external PBM claims, and confusion between budget-year claims and aggregate (AG) reporting. These inaccuracies can lead to mis-underwriting, unexpected renewals, and client dissatisfaction.
• Client Surprises Lead to Attrition: A core philosophy for client retention is to "always keep a client moving forward" and eliminate surprises. Frequent, accurate financial reporting (e.g., monthly packages) is the mechanism to ensure the client is constantly informed about their budget tracking and strategic performance.
• Operational Efficiency as a Sales Lever: While brokers are often reluctant to spend money on technology, selling operational efficiency to the agency leadership (TPAs, GAs, or carriers) who want to make brokers happy is a more effective sales strategy. The technology is a workflow management tool that reduces labor costs and improves service quality.
• Member Engagement Drives Cost Reduction: Inspired by the Asheville Project, the next frontier in cost containment is making healthcare actionable at the member level. Incentivizing members through points (tied to lower contributions) for engaging in wellness activities and consuming clinical content is proven to close gaps in care and reduce overall risk.
• The Value of Authenticity in Marketing: In a "sanitized" industry where all content looks the same, authenticity and humor are powerful tools for breaking through the noise. Taking calculated risks with marketing content, even if it seems absurd (like a marlin commercial), can generate massive engagement and associate positive feelings with the brand.
• The Necessity of Industry Collaboration: The fragmentation of the healthcare ecosystem (10,000 different islands of data and processes) is unsustainable. If industry players (carriers, TPAs, vendors) fail to collaborate and standardize data, the complexity will eventually necessitate a radical, legislative solution that "wipes everything clean."
• The Dual Role of Technology: Technology should not only automate existing processes but also enable new, strategic capabilities. For example, the ability to instantly regenerate a report with a different variable (which might take a Center of Excellence two weeks manually) allows for rapid scenario planning and better decision-making.

Tools/Resources Mentioned

• SelfInsuredReporting.com: Platform for automating financial reporting and analytics for self-funded employers.
• ACAReportingService.com: ACA compliance reporting service.
• PlanWellHealth.com: App-based solution for member wellness, disease management, and incentivization, integrated with the reporting platform.
• Asheville Project: Independently researched and peer-reviewed disease management program used as a model for member engagement strategies.
• Coefficient/Granular (Swiss Re/Google): Stop-loss carrier collaboration noted for its strategy of pulling in all available data for superior underwriting.

Key Concepts

• Self-Funded Financial Reporting: The process of tracking, analyzing, and reporting on medical and pharmacy claims, fixed costs, and stop-loss reimbursements for employers who assume direct financial risk for their employees' healthcare.
• Closing Gaps in Care: Identifying and addressing missed preventative care, non-adherence to medication, or lack of follow-up on chronic conditions, which leads to better health outcomes and lower long-term costs.
• Midpoint to Midpoint Underwriting: Financial projections and analysis conducted during the plan year (not just at renewal) to forecast the final financial outcome and potential renewal rates.
• Family Spec Deductible: A specific, complex type of stop-loss deductible structure mentioned as an example of the intricate variables software must accommodate.
• Branded Reporting: Customizing the appearance and content of reports to align with the broker or client's brand, enhancing the perceived value of the deliverable.