Win the “cost vs. care” tug of war.

Most CEOs, CFOs, and HR leaders have been led to believe that reducing their healthcare spend simply isn’t possible. By leveraging innovative strategies, we ensure that the right medical care is being provided at the right place, for the right price. Instead of accepting an 8% renewal each and every year, employers can save 20–40% on their medical spend, while improving both the quality of care and the member experience.

• We use affordability analysis to provide recommended strategies and plan designs that reduce contributions and penalties while ensuring compliance.
• Legislative compliance with all aspects of the Affordable Care Act.
• Our administration team provides end-to-end ACA employer reporting solutions, including data preparation, form generation, and form distribution.

• Medical cost inflation is having a significant impact on the employer’s bottom line with little end in sight. Reference Based Pricing provides employers with substantial savings of up to 40% on their claims spend. 
• If not managed properly, Reference Based Pricing can be disruptive to employees. It’s essential to work with a trusted partner like us to communicate the program effectively and to proactively manage potential issues.
• We recommend vendor solutions based on the employer’s unique geography, culture, and goals.  
• We offer an integrated Third Party Administrator (TPA) paired with robust employee education and engagement solutions are critical for a successful program.

• Employer direct contracting is a growing trend, increasing from 3% in 2018 to 11% in 2019.
• We can establish strategic direct contracts or leverage existing direct contracts available through the TPA or Reference Based Pricing vendor.
• Our direct contracts allow employers to leverage pricing that’s discounted off the traditional PPO Network.

• Medical experts estimate that 40-50% of all care provided is unnecessary and that only 30% of patients are going to the best-quality facilities. 
• Our Centers of Excellence programs ensure that all care provided is clinically appropriate and that it’s supplied by top quality providers at a fair price.
• Bundled pricing, avoidance of unnecessary care, and better outcomes reduce plan costs.
• With our program, employees have access to the top 10% of providers and facilities in the U.S. and receive concierge travel and care planning.

• Our pharmacy consulting team optimizes the benefits program, including better member outcomes, transparent pricing, and reduction of pharmacy spend. 
• Together we ensure that your formulary is based on the most effective drugs rather than those that pay the highest rebates. 
• We provide PBM contract review and continuous auditing, which is crucial to avoid overpaying. 
• We offer continuous review of plan performance to ensure savings and outcome opportunities during the year and at renewal are maximized.
• Our clinical programs are implemented to ensure the member is taking the appropriate medication based on medical and drug history. 
• Our program includes an integrated international pharmacy plan with savings of 30 to 70% on eligible scripts.

• Data is meaningless without action.  We utilize data analytics tools that provide actionable insight on cost, quality, and risk.  These tools are integrated with the TPA, UM firm, and employee concierge for seamless employee communication.  For example, ER visits, generic vs. brand opportunities, and place of service opportunities are used for member engagement and outreach purposes. 
• We offer plan analytics that enable employers to understand the clinical cost drivers of their health plan, including utilization and cost for procedures, diagnosis, place of service, and providers.  This allows for trend analysis for the entire plan — down to the member level.
• Our quality metrics are derived from evidence-based medicine and quality standards identify member gaps in care.
• We help identify high risk and emerging high-risk members through predictive modeling.
• We provide executive analytics dashboards along with custom reporting with benchmarking data to meet the employer’s complex reporting needs.

Direct Primary Care is a growing trend that employers are increasingly taking advantage of. Studies show that when patients spend more time with their primary care providers, their health improves and their medical spend decreases. With more time for each patient, physicians can practice up to the extent of their license and will refer to specialists less often.

• We develop a comprehensive benefits portfolio for each client with careful consideration of how the products complement each other.
• The market is saturated with voluntary products with varying costs and benefits.  We recommend appropriate, cost-effective products that provide financial protection while avoiding over-insurance.
• We provide unique product ideas, including:
  • Expense-based accident plan
  • Lump-sum long-term disability
  • Executive medical reimbursement plan
  • Universal Life with long-term care