Point, click, see your claim paid

A King of Prussia firm that manages health benefits has used the Web to simplify the process.

By Claire Furia Smith
FOR THE PHILADELPHIA INQUIRER


Headlines
"Self-directed health plans shift risk, cost to workers" - ACH in the Christian Science Monitor
August 12, 2002

"Uncovering Unbundling" - Article Featured in Human Resource Executive
May 3, 2002

"40 under 40" - Philadelphia Business Journal lists Clelland Green
March 29, 2002

ACH CEO Named to CareGain Board of Advisors
February 26, 2002

New model applies Internet to realize managed care's potential
November 1, 2001

Inc 500 rates America's Choice in country's top 500 growing companies
October 30, 2001

Philadelphia Business Journal features America's Choice
October 29, 2001

Philadelphia Inquirer features America's Choice
April 9, 2001

ACH Newsroom Main Page



CEO Clelland Green of America's Choice say's he's "always been a believer" in technology. As the online service has grown, revenues have soared. Derek Keevil designs Web pages for the firm. The database that Green built is accessible to employers. employees and health-care providers.

Clelland Green said he knew that clients of his benefits-administration business were frustrated with the amount of paperwork required to make even a routine change in a health plan.

So Green, who said he had always been a fan of technology, turned to the Internet to transform his King of Prussia business, America's Choice Healthplans Inc.

Launched in August 1999, the online service allows human-resources personnel and other employees to go online to check on a claim as it is being processed, view an online directory of doctors in a plan, request an identification card, or subtract or add a dependent on a policy.

"People love this," said Green, chief executive officer of America's Choice. "They just click on a claim to find out the status and how it was paid."

Third-party administrators are not health insurers. Rather, they handle the administrative work involved with running companies' benefits plans, including determining coverage, billing companies, and paying doctors and other providers.

"We do everything an insurance company does except take risks," said Green, 38, of Newtown Square, who has been in the third-party-administration business for 13 years.

Before founding America's Choice in 1994, Green cofounded a managed-care administrative firm in Cherry Hill called Cox-Green Associates Inc. in 1987. That firm grew rapidly, and was named to the 1993 list of the fastest-growing privately held companies in the area by the Wharton Small Business Development Center.

Green served as president and chief operating officer of Cox-Green until 1994, when he founded America's Choice, which made the same list in 1999 (at No. 58) and 2000 (No. 26).

Green, a graduate of Upper Moreland High School and Dickinson College, said he had built the computer database that tracks all sales and marketing activity for America's Choice. He also wrote the first version of his firm's check-printing database, and a document builder that automates clients' health-plan booklets.

"I love IT [information technology]," Green said. "I've always been a big believer in technology."

The Montgomery County firm, whose customer base includes more than 100 companies, caters to outfits with employees in multiple states. Green said his company also had contracts with health-care providers, including hospitals, doctors, physical therapists and laboratories, even in sparsely populated areas such as the Mojave Desert. Employers, employees and providers can all log on from work or home.

America's Choice's competitors include large traditional insurers, such as UnitedHealthcare and Aetna Inc., as well as small online third-party administrators such as WebTPA.com, of Irving, Texas, and P5e.Health Services Inc., of Salt Lake City. One of the nation's largest third-party administrators, Brokerage Concepts Inc., also is based in King of Prussia.

At America's Choice, revenues have increased from $1.3 million for the year ended June 30, 1998, to $4.2 million for the year ended June 30, 2000. Green projected that the company would have revenues of $8 million this fiscal year.

The company now has 95 employees.

"Online benefits are clearly . . . something that's here now," said Mike Young, a senior vice president at Aon Consulting Inc., of Conshohocken, where he heads the health and welfare practice. "But the larger insurance carriers have been slower to move into that arena than the smaller and more flexible" third-party administrators.

America's Choice received $4.5 million in funding last year from Eureka Growth Capital Fund, a venture fund managed by Berwind Financial Group, of Philadelphia.

America's Choice, which charges about $20 per employee per month for its service, continues to target self-insured companies with 200 to 5,000 employees.

Its customers include Bottomline Technologies Inc., of Portsmouth, N.H.; Envirosource Inc., of Horsham; and Select Medical Corp., of Mechanicsburg, Pa., which acquired the NovaCare rehabilitation business, of King of Prussia, in November 1999.

The Philadelphia Phillies also tapped America's Choice to manage the health-insurance policies of its front-office staff, scouts and trainers. JoAnn Marano, benefits administrator for the Phillies, said the new system was saving her a lot of time.

"I can check claims on the Internet myself rather than having to wait for a rep to call back," Marano said. "I can log on, enroll, delete and terminate policies."

The service is ideal for the staff of the Phillies, which often is scattered all over the country, Marano said.

Green said that, unlike insurers, which often try to curb costs by limiting services, America's Choice operates under the philosophy that providing employees with extra assistance in managing their health saves money in the long run.

"We believe that 6 percent of the people generate 60 percent of the costs," Green said. "We want to make sure that 6 percent gets all the care they need."

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