Medxoom - One App To Connect It All! - Pricing, Communications & Payments for Health Plans

This video provides an in-depth exploration of Medxoom, a technology platform designed to unify health plan management, communications, pricing, and payments through a single, intuitive application. James Walsh, EVP of Strategy and Growth at Medxoom, details how the platform aims to significantly improve financial outcomes for both health plans and their members by tackling the pervasive issues of healthcare cost opacity and member disengagement. The discussion highlights Medxoom's role as a cutting-edge problem-solving technology in the healthcare space, emphasizing its ability to bring cohesion to traditionally siloed healthcare components.

The core of Medxoom's value proposition lies in its true white-labeled member experience. The platform integrates a myriad of health plan solutions—ranging from Telehealth and Direct Primary Care to carved-out PBMs and Reference Based Pricing—into one singular, easy-to-use application. This consolidation allows members to access a benefits wallet, search for care, engage with care navigators, and align with providers on pricing, all from a single point of access. A key to Medxoom's success in driving member engagement, with reported adoption rates exceeding 70% within the first week of launch for some clients, is the strategic decision by employers to go fully digital, often eliminating traditional plastic ID cards.

Medxoom also stands out for its robust data engineering capabilities and intelligent automation. The platform ingests vast amounts of data, including machine-readable files from 3rd-party providers, to ensure compliance with the Consolidated Appropriations Act (CAA) and facilitate price transparency for members. An innovative future initiative involves proactive care intervention: the app will be able to recognize when members search for potentially serious procedures and trigger an immediate outreach from a case manager. This proactive approach aims to prevent negative health outcomes, optimize care pathways, and negotiate better pricing, thereby reducing the need for costly reactive interventions. Furthermore, Medxoom addresses the critical payment problem in healthcare through its "Single Payment Credential" (SPC Card), a single-use virtual credit card loaded with plan dollars, enabling closed-loop transactions and full payment to providers at the point of service. This system has achieved 100% provider acceptance and demonstrated a remarkable 40% reduction in unit costs compared to traditional network arrangements.

Key Takeaways:

• Addressing Healthcare Opacity: The current healthcare system intentionally keeps individuals in the dark about costs, leading to financial burdens and suboptimal decisions. Medxoom aims to reverse this by providing transparent pricing information.
• Unified Member Experience: Medxoom offers a white-labeled application that consolidates all health plan components (Telehealth, DPC, PBMs, RBP, PPO, no-network plans) into a single, user-friendly interface for members.
• Driving Member Engagement: High adoption rates (over 70% downloads/enrollment) are achieved by strategies such as eliminating physical ID cards and leveraging proactive outreach from care navigators.
• CAA Compliance & Data Integration: The platform ingests machine-readable files from various data sources to ensure compliance with CAA transparency laws, allowing members to search for CPT codes and understand unit costs.
• Proactive Care Intervention with AI: Medxoom's app can detect searches for serious procedures and trigger an alert to a case manager, enabling proactive outreach to members to guide them to appropriate, cost-effective care.
• Innovative Payment Solution (SPC Card): The "Single Payment Credential" (SPC Card) is a single-use virtual credit card loaded with plan dollars, facilitating direct, full payment to providers at the point of service.
• Significant Financial Impact: The SPC Card has achieved 100% provider acceptance and resulted in an average 40% reduction in unit costs compared to traditional network arrangements, solving common friction points like balance billing.
• Empowering Plan Fiduciaries: The CAA places a greater onus on employers to act as fiduciaries, and Medxoom provides the tools and data necessary for them to make informed, cost-effective decisions for their plans.
• Marketplace for Healthcare Services: Medxoom functions as a marketplace, aggregating direct contracts, bundled services, and content providers to offer members a wide range of vetted, cost-transparent care options.
• Scalability Across Employer Sizes: The platform is an enterprise-level solution that serves employer groups of all sizes (from 1 to tens of thousands of employees) through TPAs, health plans, and brokers, with the greatest impact seen in the self-funded space.
• Industry Collaboration for Systemic Change: The speaker emphasizes the need for continued collaboration, innovation, and a "grassroots effort" to educate consumers and collectively steer the healthcare system towards greater affordability and efficiency.
• Addressing Healthcare Waste: The discussion implicitly acknowledges significant waste in the healthcare system, with estimates suggesting 30-40% of procedures or spending may be unnecessary, highlighting the potential for substantial savings through smarter payment and care navigation.

Tools/Resources Mentioned:

• Medxoom App: The core technology platform for unifying health plan management.
• Single Payment Credential (SPC Card): A proprietary single-use virtual credit card for direct provider payments.
• Machine-Readable Files: Data sources used for price transparency and CAA compliance.

Key Concepts:

• White-Labeled Member Experience: A customizable platform interface that reflects the branding of the client (employer, TPA, broker).
• Reference-Based Pricing (RBP): A health plan strategy where payments to providers are based on a reference price, often leading to balance billing issues that the SPC card helps mitigate.
• Consolidated Appropriations Act (CAA) Compliance: Regulations requiring health plans to disclose pricing information, which Medxoom helps facilitate through data ingestion and transparency tools.
• Unit Cost Reduction: The decrease in the cost of a single healthcare service or procedure, significantly achieved through Medxoom's payment solutions.
• Care Navigators: Third-party or in-house teams that guide members through their healthcare journey, now integrated and enhanced by the Medxoom platform.
• Direct Primary Care (DPC): A model of healthcare delivery that removes insurance from primary care, often integrated into Medxoom's unified platform.

Examples/Case Studies:

• Knee Replacement Cost Analysis: A large client's historical claims showed knee replacements costing $68,000-$92,000, while Medxoom's marketplace offered direct contracts for the same procedure at $18,000, highlighting massive potential savings.
• Foot Doctor Cash Payment: The speaker's personal experience of paying $36 cash for three X-rays, demonstrating how direct payment can drastically reduce costs compared to insurance billing.
• High App Adoption: Clients who eliminated plastic ID cards saw 70%+ download and enrollment rates for the Medxoom app within the first week of launch.