Lifelong Edina resident Jay Belschner knows a thing or two about health care. That’s because, with 25 years of experience in the field, he has learned what works—and what doesn’t. Today, as co-founder and managing partner of Certifi, a small company based in Hopkins, Belschner finds himself in the midst of the controversial federal health care system overhaul. Certifi, which was incorporated in 2006, is busy developing software to support the new health insurance exchanges that are central to the Affordable Care Act, also known as Obamacare. While there is much debate over our health care system, Belschner believes the promise of a better health care system waits on the horizon.
Belschner’s career in health care started as a member services manager at Aetna US HealthCare, where he managed Chicago and Cleveland HMO operations, and was involved in every aspect of health plan operational administration. From there he went to eBenX, a small technology startup in Minneapolis, where he created software designed to automate its internal operations, and met his future business partner, Michael Whittington. Although this company eventually sold to SHPS, Inc., it was hugely successful in the ’90s and worked with large clients like PepsiCo. “This is where we learned about how [health insurance] exchange business works,” says Belschner. But he also saw firsthand that the process required complicated data management that involved time-intensive customization and needed major tweaking. “Having to do all of that customization every week, every month, all year, put a lot of cost in the system,” explains Belschner.
Fast-forward to today. Belschner and Whittington are pioneering health care reform on a national scale through their company Certifi, by managing and simplifying the financial aspects of health insurance exchanges. The key to the process is financial transaction consolidation and accounting. “There used to be many bills and payments. Now we’re doing a consolidation at every point for every participant in the exchange, and that really gets the cost down,” says Belschner. “At the end of the day that’s really what needs to happen: We need to make health care easier to access and more affordable. And taking costs out of the administration will help that mission.”
According to Belschner, the technology behind the exchanges can best be described as a three-legged stool. First you have the online shopping experience, where consumers take their health care dollars and browse the benefit offerings to see what works best with their family. Next you have the software tools that turn those options into data, a step managed by many other companies across the country. Third, you have Certifi’s specialty: the ongoing treasury functions, consolidating billing and payment of everyone in the exchange.
“That’s what we do,” says Belschner. “We consolidate the bill so the employer only gets one bill regardless of what their employee selects in the shopping experience. Then we turn around and pay only one payment to every [health insurance company] participating in the exchange.” Instead of adding confusion and difficulty with the advent of consumer choice, Certifi aims to absorb and manage that complexity, keeping costs down and providing employers and employees with a positive and stress-free experience. “It’s like the Travelocity or Expedia for health care,” says Belschner.
Although such exchanges are not yet offered in Minnesota, states currently involved, such as Utah and Massachusetts, have already seen positive results. In fact, Belschner points out that 30 percent of the companies that joined in the exchange were not able to offer employee benefits before the exchange came along. “That’s a pretty big number,” he adds. “Regardless of what you believe politically, exchanges are an improvement and they are here to stay.”
Belschner is eager for exchanges come to Edina. The reform generally affects those citizens who struggle to afford health care, but the exchanges will also make life easier for the entrepreneur. “There are lots of small businesses in Edina, and they will be able to more easily offer benefits to employees,” he says. And not only will they have benefits, they will also have the freedom to tailor the plans to their needs, bundling benefits that the employees want and are willing to pay for with benefits the employers want them to have, such as short-term disability or wellness benefits, making both parties happy.
“We are so excited to be a part of this history,” says Belschner, who had no idea when he graduated from Edina High School that he was destined for health care administration. “It was kind of an ‘accidental tourist’ experience, but I couldn’t have picked a better time in the history of the country to be in something so exciting.”
