Score and Baseline Plan Cost

The first step is to check plan cost for current period and upcoming renewal if applicable. We then score the plan effectiveness depending on the current responsiveness of the plan, meaning, do you know what is driving rate increases? Can you get plan data on your employees and dependents from your current carrier? Do your employees appreciate their current plan coverage? Can you use your plan as a recruiting tool?

Historical Claims Data

With the passage of federal and California Interoperability laws in 2022 it is becoming possible to retrieve claims data for every member on your plan and not have to beg your insurance company to provide the data to you when it may not be in their best interest to do so.

Prescription Cost Control

The cost of prescriptions are exploding. Especially if you do not have a transparent pharmacy benefits manager (PBM). Prescription cost, especially specialty drugs are becoming on par with the cost of medical services.

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Understand the details of so-called "rebates" and how spread pricing on generics can be decieving.

Direct Primary Care

Various audits have found installation of DPC can save the plan well over 20%. Why? In 2021 Forbes cited that 27% of employees delay, or do not get care at all because they are not sure if it is covered by their plan. Well, what happens? The employee gets sicker and sicker, until finally, what could have been a minor inconvenience ends up in a potentially catastrophic, and very expensive emergency hospital procedure.

Structured Insurance

The Affordable Care Act offers significant advantages for properly structured  fully insured and self-funded plans. Typically the company will realize more than a 20% cost savings AND provide free ER and Urgent Care visits to their employees base.

Cost Plus Claims Auditing

If we operate a self-funded plan and are not in a rural area, it is always appropriate to consider installing a Cost Plus Auditing Program (CPAP), when done correctly provides a line-by-line audit of health care expenses with complete and utter transparency. We can then pre-negotiate services and not suffer at the mercy of the hospital and healthcare system.

Second Opinion Program

Misdiagnosis is rampant. One-out-of-10 patients with cancer, an infection, or a major vascular event, such as a heart attack or stroke, are misdiagnosed each year. One-in-5, or 20% of Americans with serious illnesses are misdiagnosed.

In this step we look at how including Second Opinion in your plan impacts your company ROI and what it can mean for employees.