Devoted to Broker Success- Differentiate
-
ACA Marketplace Problems
- Cost Modeling
- Healthcare Consumption Audit
ACA Marketplace Problems
Presentation identifies the cost drivers, by design, that drive fully insured group health insurance premiums. Our business is conducted to a Fiduciary Standard and all service is classified as “concierge.”
Our focus is on the ERISA Self-Insured market, beginning at 25 covered employee lives in some markets. We are experts in crafting benefits to match employer’s culture; all alternative funding concepts, Direct Primary Care Networks, Networks, and Reference Based Pricing integration. We have all the “Next Generation” administration, services and products. 80% of group health solutions are now self-insured! The number is increasing.
Cost Modeling
Cost Modeling - Self-insured employers with 50+ employees on their plan:
Claim repricing and vendor vetting for replacing vendors with 100% transparency and business to a Fiduciary Standard. Implementing “Best in Class” vendors reduces spending up to 25% and improves Benefit Satisfaction. Data mine 24 months of Healthcare and Rx Claims. Reprice all consumed healthcare. This will illustrate any overcharging in your current claim adjudication process. Checking your PBM’s charges per script written will expose excess profiteering.
Check your benefit vendors for accuracy and integrity. Recommend new vendors when needed for claim adjudication, network, administration, and Pharmacy Benefit Management. Recommended vendors are 100% Transparent & do business to a Fiduciary Standard which will increase benefit satisfaction and reduce benefit cost.
Healthcare Consumption Audit
Is there a new simpler approach to Health Plan Financial Analysis or Healthcare Consumption Audit? I believe so. Scott Hettesheimer has 43 years of experience as a consultant and strategist helping employers evaluate and select health benefit plan service providers. This discussion is intended to illustrate the complexity wrapped in "Healthcare Business As Usual."
Sell No-Network every provider is in and Transparent Pharmacy delivered from a fiduciary standard.
Read More
"The End of Healthcare Business as Usual."
Read More