Experts Speak Out: January 1 Nightmares

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We sat down with two industry veterans to discuss the state of the new plan year. Here's what they had to say. This vlog is also available on YouTube.

‍Vlog Transcript‍‍

Jim: Every January 1st, the same thing happens.

‍Ernie: Uh, a train wreck. A nightmare. A travesty of pain. The worst part is everyone is used to it. Our industry just accepts it as reality, even though it doesn’t have to be.

‍Jim: My name is Jim Hayes. I spent my career working at a TPA and then a large CDH platform. I’ve lived through more Januaries than I want to admit, and they were all chaotic. But this year is different.

‍Ernie: Jim, I agree. I think this year is different. My name is Ernie Harris. I’ve worked at a few platform providers and TPAs, and now I conveniently work at the same platform as Jim. This January feels different for us. What do you think is the primary cause?

‍Jim: I’m thrilled to be at Elevate, and this January has been very different. For context, around 75–80% of benefits renew on January 1. Employees either pick new plans or stay in the same ones, and new money hits accounts. That creates issues. Accounts aren’t funded correctly, cards don’t arrive, cards don’t work, and people are enrolled in the wrong plans. The chaos rolls downhill to customer service teams. What did I miss?

‍Ernie: I like to use an acronym I made up: the irresistible force. It’s funding events, onboarding events, renewals, cards, and new elections. All of it compounds around January 1. TPAs accept this busy season. They staff up with temps and change processes to work around broken technology. Every year it gets worse, and we accept it. But I don’t think we have to. There are other options. What do you think?

‍Jim: I agree. Why do you think we’ve accepted it for so long? We’ve both worked at places where chaos was expected. Why?

‍Ernie: There are a few reasons. As an industry, we started on paper, then added more paper. Then computers came along, then websites, then mobile apps. But we’re still at the tail end of that second transformation. The change happened slowly and incrementally. It’s the frog in boiling water. The temperature rises a little at a time, and you don’t notice. It’s been two decades since a major platform reset. Now we’re at the start of another one.

‍Jim: You started with paper. I thought you were going to say papyrus. We’ll save that for another episode. What’s wild is how reactive admins become. January hits, it’s all hands on deck, and everyone works overtime. If nothing changes, next year looks the same. Different problems, same chaos. There were Januarys where I wondered if I’d see my family because all my free time went to troubleshooting.

‍Ernie: Same here. This year was different. New Year’s Day, no email. Christmas Day, no email. Some tickets, sure. Normal run-and-maintain work. The two weeks between Christmas and New Year were the most relaxing I’ve had in 15 years.

‍Jim: Agreed. You still nervously check your phone on January 1 and 2, waiting for something to blow up. It didn’t. We weren’t perfect, but issues were solvable during business hours and in partnership with others. That’s a huge change. One partner told us it felt like a normal January. Busy, but not crazy. Another partner grew 50% last year, and their touchpoints per customer dropped 60%. That’s why January was manageable. A strong platform removes chaos.

‍Ernie: So what does good actually look like? Everyone claims to be industry-leading. I’m in sales, I say it too. But there are real signals. One is real-time operations. That stat you mentioned is huge. In batch systems, fixes aren’t immediate. They run later, and there’s no transparency. Someone calls back the next day and says, “I thought you fixed it.” You did. It’s just pending. That creates follow-on tickets. Transparency matters too. Cards are a great example. Jim, can you talk about card transparency?

‍Jim: Cards are always an issue. Did they ship early enough? Will they arrive by December 30? Then people lose them, think they lost them, or the card doesn’t work. We implemented a card tracker so participants and partners can see:

• When the card was ordered
• When it shipped
• When it’s expected to arrive
• Confirmation when it does
• That alone can eliminate calls. Fewer touchpoints mean more time for higher-value issues. That’s what good platforms do. They reduce problems instead of creating them.

‍Ernie: Silence is golden. That’s the takeaway. We’re not stuck, and this isn’t inevitable. People blame staff when things go wrong, but in my experience it’s rarely the people. It’s how the business is set up and the infrastructure underneath it. Do a postmortem, not September 1, but March 1. Fix it before next January.

‍Jim: Agreed. This has been fun, Ernie. If we get more viewers than your mom and my mom, we should do another one. If January is a problem for you, something upstream is broken. And if your platform contributes to it, you need to look at that.

‍Ernie: Completely agree. And in the immortal words of Smokey Bear, only you can prevent January 1 fires.

‍Jim: Thanks, Ernie.